| NPI | 1760080964 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAYLYN P WELCH Owner 843-801-3695 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2020-10-12 |
| Last Update Date | 2024-06-07 |