Organization
UNICARE
Active
Organization
UNICARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RODERICK ROBERTSON (MANAGER)
(803) 446-0487
Entity
Organization
Contact information
Practice address
18 WALLBROOK CT, IRMO, SC 29063-8237
(803) 446-0487
Mailing address
18 WALLBROOK CT, IRMO, SC 29063-8237
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
05/27/2010
Last updated
05/27/2010
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