| NPI | 1649915216 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID 'CARSON' MOORE Owner/Authorized Official 843-324-7575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine |
| 208000000X Pediatrics | |
| 2080A0000X Pediatrics, Adolescent Medicine | |
| Enumeration Date | 2022-04-28 |
| Last Update Date | 2023-01-30 |