Individual
MRS. JILL M. MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
803 ANTREVILLE HWY, IVA, SC 29655-9512
(863) 348-6400
(864) 348-7071
Mailing address
PO BOX 118, IVA, SC 29655-0118
(964) 348-6196
(864) 348-6198
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
18694
SC
Other
Enumeration date
05/16/2013
Last updated
05/16/2013
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