Organization
WATERWAY PRIMARY CARE,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT ALI FAILE III (AUTHORIZED OFFICIAL)
(843) 856-7924
Entity
Organization
Contact information
Practice address
3600 SEA MOUNTAIN HWY, LITTLE RIVER, SC 29566-8161
(843) 399-4848
Mailing address
3600 SEA MOUNTAIN HWY, LITTLE RIVER, SC 29566-8161
(843) 399-4848
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
11/22/2013
Last updated
11/25/2013
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