Individual
MR. HARRY DONTRELL BURGESS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
122 SANDERS DR, COWARD, SC 29530-5509
(843) 598-9420
Mailing address
122 SANDERS DR, COWARD, SC 29530-5509
(843) 598-9420
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
10655
SC
Other
Enumeration date
09/15/2016
Last updated
09/15/2016
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