Individual
MS. JUANITA RIVERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
145 FAITH CHURCH RD, SWANSEA, SC 29160-9760
(803) 378-6146
(803) 568-0001
Mailing address
PO BOX 335, SWANSEA, SC 29160-0335
(803) 378-6146
(803) 568-0001
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
007236626
SC
Other
Enumeration date
04/14/2015
Last updated
04/14/2015
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