| NPI | 1881138535 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARGIE CERVANTES Administration 803-648-0056 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: SC 6955) |
| Enumeration Date | 2016-12-15 |
| Last Update Date | 2016-12-15 |