| NPI | 1730596685 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH RAY WARRICK Owner 843-399-9965 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207NS0135X Dermatology Procedural Dermatology |
| Additional Taxonomies | 207N00000X Dermatology |
| Enumeration Date | 2014-07-11 |
| Last Update Date | 2022-08-18 |