Individual
JESSICA DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
331 WILSON BRIDGE RD, FOUNTAIN INN, SC 29644-9055
(864) 436-3332
Mailing address
331 WILSON BRIDGE RD, FOUNTAIN INN, SC 29644-9055
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
12/08/2021
Last updated
12/08/2021
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