Individual
JODI KINKEAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1275 21ST AVE N, MYRTLE BEACH, SC 29577-7514
(843) 448-9977
Mailing address
1275 21ST AVE N, MYRTLE BEACH, SC 29577-7514
(843) 448-9977
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD10836
SC
Other
Enumeration date
06/15/2015
Last updated
06/15/2015
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