| NPI | 1437692407 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYRONE DELMAR WALLACE Owner 843-394-8274 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: SC SC 1873) |
| Enumeration Date | 2016-11-23 |
| Last Update Date | 2016-11-23 |