| NPI | 1508515842 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYNAKA KWANS WILSON Family Nurse Practitioner 843-206-5346 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2022-03-23 |
| Last Update Date | 2022-03-23 |