| NPI | 1467598920 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL K MIKKELSON Owner Physician 843-757-5400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 15315) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2013-04-18 |