| NPI | 1962830216 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHEN DOUGLAS HEAD Manager 803-673-4788 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: SC 8070) |
| Enumeration Date | 2013-10-24 |
| Last Update Date | 2013-10-24 |