Individual
KAREN BOULANGER PACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3424 SHELBY RAY CT, CHARLESTON, SC 29414-5838
(843) 402-6834
(843) 573-9963
Mailing address
4416 FOREST DR, 2ND FLOOR, COLUMBIA, SC 29206-3104
(803) 782-4278
(803) 782-3445
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
668
SC
Other
Enumeration date
06/30/2006
Last updated
07/08/2007
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