Organization
AESTHETIC CENTER FOR BREAST AND COSMETIC SURGERY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SUTTON LEWIS GRAHAM II MD (OWNER)
(864) 676-1707
Entity
Organization
Contact information
Practice address
615 HALTON RD, GREENVILLE, SC 29607-3403
(864) 676-1707
(864) 676-9256
Mailing address
615 HALTON RD, GREENVILLE, SC 29607-3403
(864) 676-1707
(864) 676-9256
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
11893
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP0192
—
SC
Enumeration date
07/02/2015
Last updated
07/02/2015
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