| NPI | 1619211224 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS B BURRELL Business Manager 843-652-8123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2012-11-20 |
| Last Update Date | 2012-11-20 |