Organization
WELLNESS BOUTIQUE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MCHELLE S QUAYE MD (MEDICAL DIRECTOR)
(843) 861-2726
Entity
Organization
Contact information
Practice address
107 W COLLEGE AVE, HARTSVILLE, SC 29550-4113
(843) 861-2726
Mailing address
PO BOX 1763, HARTSVILLE, SC 29551-1763
(843) 861-2726
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
22891
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
28916
—
SC
Enumeration date
08/14/2012
Last updated
09/13/2012
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