| NPI | 1518177807 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AEOLAIN FUNDERBURG Receptionist 803-534-5444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: SC 1223P0106X) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2008-06-30 |