Individual
HAYLEE SAMANTHA BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
147 TIBTON CIR, MYRTLE BEACH, SC 29588-1266
(843) 467-7946
Mailing address
147 TIBTON CIR, MYRTLE BEACH, SC 29588-1266
(843) 467-7946
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/11/2019
Last updated
01/11/2019
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