| NPI | 1013435429 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLI GRAY Business COO Rdinator 803-641-3883 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: SC 3587) |
| Enumeration Date | 2017-09-06 |
| Last Update Date | 2017-09-06 |