| NPI | 1669662516 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH RAY WARRICK President 803-546-7522 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TN 40472) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: TN 40472) |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2009-09-01 |