Individual
RICHARD GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.PED
Contact information
Practice address
1671 LAKE MURRAY BLVD, COLUMBIA, SC 29212-8626
(803) 269-3546
(803) 407-9195
Mailing address
1671 LAKE MURRAY BLVD, COLUMBIA, SC 29212-8626
(803) 269-3990
(803) 407-9195
Taxonomy
Speciality
Code
Description
License number
State
224L00000X
Pedorthist
Primary
CPED0707
SC
Other
Enumeration date
08/05/2024
Last updated
08/05/2024
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