| NPI | 1013123983 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH JANE BJORNSON Officer 843-881-9909 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: SC 0352) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2020-08-22 |