| NPI | 1003320003 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA KING RUCKER President 803-832-4446 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: SC 3431) |
| Enumeration Date | 2017-11-29 |
| Last Update Date | 2018-03-17 |