| NPI | 1669701827 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLAS J LICARY Agent For Corporation 843-712-1854 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Enumeration Date | 2009-12-17 |
| Last Update Date | 2014-11-20 |