Individual
SARA JANE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
108 WILLOW OAK CT, SIMPSONVILLE, SC 29681-4962
(864) 979-6674
Mailing address
108 WILLOW OAK CT, SIMPSONVILLE, SC 29681-4962
(864) 979-6674
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
03/09/2017
Last updated
03/09/2017
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