| NPI | 1487031001 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN E KLECKLEY Owner 843-209-1454 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: SC 29749) |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2015-05-04 |