Individual
MOL KY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
333 REVOLUTIONARY TRAIL, FAIRFAX, SC 29827
(803) 632-2533
Mailing address
PO BOX 990, 333 REVOLUTIONARY TRAIL, FAIRFAX, SC 29827
(803) 632-2533
(803) 632-2451
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
MD01101TL
SC
Other
Enumeration date
09/07/2007
Last updated
09/07/2007
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