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 |