| NPI | 1952452914 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARYN RAE Director 843-876-1344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2011-11-30 |