Organization
SOUTHEAST NEUROPATHY & TREATMENT CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GLENN GRAY (CORPORATE COMPLIANCE OFFICER)
(803) 240-5399
Entity
Organization
Contact information
Practice address
1494 LAKE MURRAY BLVD, 1ST FLOOR, COLUMBIA, SC 29212-8697
(803) 240-5399
(803) 791-1634
Mailing address
PO BOX 26, IRMO, SC 29063-0026
(803) 240-5399
(803) 791-1634
Taxonomy
Speciality
Code
Description
License number
State
261QP3300X
Pain Clinic/Center
Primary
—
—
Other
Enumeration date
03/07/2014
Last updated
03/07/2014
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