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Individual

TAMARA PETERSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
220 CLIVE ST, COLUMBIA, SC 29204-3021
(803) 530-5314
Mailing address
4840 FOREST DR, SUITE 6-B, #259, COLUMBIA, SC 29206-4810

Taxonomy

Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary

Other

Enumeration date
05/19/2014
Last updated
05/19/2014
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