Individual
JACQUELYN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2000 N BELTLINE BLVD APT 102E, COLUMBIA, SC 29204-3976
(803) 814-2566
Mailing address
2000 N BELTLINE BLVD APT 102E, COLUMBIA, SC 29204-3976
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
05/31/2017
Last updated
05/31/2017
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