| NPI | 1821089434 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN N ANDERSON President 843-689-9720 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: SC 16696) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2008-04-20 |