Loris Medical Center, PA

NPI #1740216191 in Loris, South Carolina

Provider Information

NPI Number: 1740216191
Entity Type: Organization
Organization Name: Loris Medical Center, PA
Primary Specialty: Family Medicine
Enumeration Date: Jun 25, 2006
Last Updated: Sep 10, 2009

Practice Location

Address: 3439 CASEY ST
City: Loris
State: South Carolina
ZIP Code: 29569-2903
Phone: (843) 756-1582

Authorized Official

Name: MRS. WANDA GRAHAM
Title: PRACTICE ADMINISTRATOR
Phone: (843) 756-5300

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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