| NPI | 1306521752 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNDA TYLER Controller 843-974-5236 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2023-06-21 |
| Last Update Date | 2023-06-21 |