Individual
KOURTLAND HAILE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2020 LAUREL ST, COLUMBIA, SC 29204-1019
(803) 524-4543
Mailing address
2020 LAUREL ST, COLUMBIA, SC 29204-1019
(803) 524-4543
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
9376
SC
Other
Enumeration date
06/03/2019
Last updated
06/03/2019
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