Individual
ADDIE MOULTRIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
301 PALMETTO PARK BLVD, LEXINGTON, SC 29072-7872
(803) 996-1500
Mailing address
1018 PINE ST, CAYCE, SC 29033-3408
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
49640
SC
Other
Enumeration date
11/16/2014
Last updated
11/16/2014
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