| NPI | 1568357465 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA LUCKIE Co Owner 843-225-9810 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| Enumeration Date | 2025-06-11 |
| Last Update Date | 2025-06-11 |