| NPI | 1588614192 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS W PETRUSICK Owner/Physician 843-449-1438 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: SC 7085) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2014-02-25 |