| NPI | 1568585966 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBORAH TULLY Business Manager 843-903-4401 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC F 2018) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2020-08-22 |