| NPI | 1619425261 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARDEAN CLOVENA GIBSON WINGATE Massage Therapist 843-245-4708 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: SC MAS 7994) |
| Enumeration Date | 2016-09-13 |
| Last Update Date | 2016-09-13 |