| NPI | 1881085918 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HARRY NICKEY GORE COO 843-756-3008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2015-02-11 |
| Last Update Date | 2015-03-18 |