| NPI | 1760560601 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH PATRICK MARKOVICH Director 843-884-6194 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NR0400X (Licence: SC 1830) |
| Additional Taxonomies | 208D00000X General Practice (Licence: SC 15987) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2020-08-22 |