| NPI | 1740820596 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARYN RAE Director 843-876-1344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207R00000X Internal Medicine | |
| Enumeration Date | 2020-01-09 |
| Last Update Date | 2020-01-09 |