| NPI | 1013273549 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MALLOY GROVES SCOTT Officer 843-379-9200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: SC 4410) |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2015-02-06 |