| NPI | 1922022417 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARON R OWENS Office Manager 843-884-1217 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0000X Family Medicine, Adolescent Medicine (Licence: SC 207QA0000X) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2020-08-22 |