| NPI | 1699474205 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN DONALDSON Partner 843-884-8045 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208800000X Urology |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2023-03-02 |
| Last Update Date | 2023-09-25 |