Individual
BRIAN J BLACKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
A.T., C.
Contact information
Practice address
104 SALUDA POINTE DR, LEXINGTON, SC 29072-7295
(803) 413-0220
Mailing address
104 SALUDA POINTE DR, LEXINGTON, SC 29072-7295
(803) 413-0220
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
379
SC
Other
Enumeration date
10/06/2006
Last updated
10/06/2014
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