| NPI | 1629379839 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARRIE R WALTERS Practice Administrator 843-832-5096 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 1595TL) |
| Enumeration Date | 2010-11-04 |
| Last Update Date | 2010-11-04 |