| NPI | 1710253372 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRISH BUKAUSKAS Consultant 843-902-1520 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: FL OS0003700) |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2012-04-10 |