| NPI | 1487051439 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUNE PATENAUDE Credentialing Coordinator 843-576-2600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2014-11-19 |
| Last Update Date | 2014-11-19 |