| NPI | 1710849369 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAISHA JERRICE GREEN Owner/Operator 843-260-0529 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine |
| Enumeration Date | 2025-12-02 |
| Last Update Date | 2025-12-02 |