| NPI | 1487765897 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERALD E TILLER Owner 843-546-8421 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: SC ASF090) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-10-23 |