| NPI | 1710404454 |
|---|---|
| Doing Business As | SOUTH CAROLINA |
| Entity Type | Organization |
| Authorized Contact | KELLY JACK Ar Technical Manager 856-782-2212 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine |
| Enumeration Date | 2017-08-24 |
| Last Update Date | 2022-07-21 |