| NPI | 1760696173 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICK MICHAEL JORDAN Owner 843-341-3232 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 14780) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2012-10-26 |