| NPI | 1942305388 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL PROVENZANO Regional Practice Manager/A VP 843-777-7030 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family |
| 261QR1300X Clinic/Center Rural Health | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2009-03-27 |