| NPI | 1760736763 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY D RABON Owner 843-665-2200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: SC 05395) |
| Enumeration Date | 2012-10-30 |
| Last Update Date | 2012-10-30 |