Individual
MS. MARISA ELIZABETH TETREAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
612 DEVINE ST UNIT 434, COLUMBIA, SC 29201-5276
(704) 473-5172
Mailing address
612 DEVINE ST UNIT 434, COLUMBIA, SC 29201-5276
(704) 473-5172
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
06/04/2018
Last updated
06/04/2018
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