| NPI | 1750800520 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMUEL CLARK TRASK Owner 843-524-2001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: SC MD22623) |
| Enumeration Date | 2017-09-13 |
| Last Update Date | 2023-03-07 |