Individual
MARK EDWARD BOULDEN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
2185 N FRASER ST, GEORGETOWN, SC 29440-6418
(843) 527-1800
(843) 527-6528
Mailing address
2185 N FRASER ST, GEORGETOWN, SC 29440-6418
(843) 527-1800
(843) 527-6528
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1667
SC
Other
Enumeration date
07/15/2016
Last updated
07/15/2016
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