| NPI | 1629460381 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD BLAKE KLINE Owner 843-438-8470 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine |
| Additional Taxonomies | 207L00000X Anesthesiology |
| 207LP2900X Anesthesiology Pain Medicine (Licence: SC 20364) | |
| 207QA0505X Family Medicine Adult Medicine | |
| 225100000X Physical Therapist | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 363AM0700X Physician Assistant Medical | |
| Enumeration Date | 2015-03-04 |
| Last Update Date | 2022-04-20 |