| NPI | 1508189838 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER KNAPP Credentialing Specialist 843-408-4171 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: SC 19977) |
| Enumeration Date | 2010-03-01 |
| Last Update Date | 2010-03-03 |