| NPI | 1962881268 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JIN LI DONG Owner 843-692-9243 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: SC MD18446) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty (Licence: SC 27) |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2015-05-20 |