Individual
KWATERRIA MANDAJH GLOVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1411 RIVERWALK WAY, IRMO, SC 29063-8489
(803) 522-8858
Mailing address
1411 RIVERWALK WAY, IRMO, SC 29063-8489
(803) 522-8858
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
2017-53912-52801
SC
Other
Enumeration date
10/17/2017
Last updated
10/17/2017
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