| NPI | 1932291242 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS ANDREW NOVINGER Owner/Physician 843-921-4851 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 21964) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2018-10-02 |