Individual
MARY DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1070 S LAKE DR, SUITE B, LEXINGTON, SC 29073-3701
(803) 785-6626
Mailing address
395 PIONEER SHORES RD, PROSPERITY, SC 29127-8938
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
94370
SC
Other
Enumeration date
04/16/2014
Last updated
04/16/2014
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