| NPI | 1831252477 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI NOEL MOCK Practice Administrator 843-524-8171 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0129X |
| Additional Taxonomies | 208600000X Surgery |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2025-09-11 |