| NPI | 1649331380 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY L COSTELLO Owner 843-839-5588 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: SC SC2755) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2009-05-11 |