Organization
INTERCOSTAL NONSURGICAL DIAGNOSTIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK WISE DC (OWNER)
(864) 847-6020
Entity
Organization
Contact information
Practice address
24 E MAIN ST, WILLIAMSTON, SC 29697-1925
(864) 847-6020
(864) 840-9668
Mailing address
24 E MAIN ST, WILLIAMSTON, SC 29697-1925
(864) 847-6020
(864) 840-9668
Taxonomy
Speciality
Code
Description
License number
State
405300000X
Prevention Professional
Primary
—
—
Other
Enumeration date
03/13/2017
Last updated
03/13/2017
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