| NPI | 1871666958 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON LEE KIGGINS Owner 843-347-2273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: SC 3421) |
| Additional Taxonomies | 208D00000X General Practice (Licence: SC 3095) |
| 208D00000X General Practice (Licence: SC 3287) | |
| 208D00000X General Practice (Licence: SC 3314) | |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2020-08-22 |