Individual
MRS. BRAE DEWALT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
101 POTTERY CIR, SUMMERVILLE, SC 29483-8095
(843) 771-2934
Mailing address
2097 PIMLICO DR, RIDGEVILLE, SC 29472-5951
(619) 721-5407
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
—
—
Other
Enumeration date
02/07/2024
Last updated
02/07/2024
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