| NPI | 1699960054 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOMENIC J DEMICHELE Owner 843-669-1615 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: SC 15062) |
| Enumeration Date | 2007-09-10 |
| Last Update Date | 2007-09-12 |