Organization
INTEGRATED WOUND CARE SOUTH CAROLINA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DIANE LUSAS MD (AUTHORIZED OFFICIAL)
(718) 963-3495
Entity
Organization
Contact information
Practice address
1703 LAUREL ST, COLUMBIA, SC 29201-2660
(718) 963-3495
Mailing address
492C CEDAR LN STE 514, TEANECK, NJ 07666-1713
(718) 963-3495
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
06/05/2023
Last updated
06/05/2023
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