Individual
LAINE BLANK WAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
50 E HOSPITAL ST STE 3, MANNING, SC 29102-3149
(803) 435-8828
(843) 435-2239
Mailing address
PO BOX 3239, FLORENCE, SC 29502-3239
(803) 435-8828
(803) 435-2239
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
82721
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
827216
—
SC
Enumeration date
03/21/2019
Last updated
07/06/2022
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