Individual
AUDREY TISE KAZER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
570 CENTER RD, CHESTER, SC 29706-6880
(336) 749-1015
Mailing address
PO BOX 1597, KING, NC 27021-1597
(336) 749-1015
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
RC-1399
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RC-1399
—
SC
Enumeration date
12/11/2017
Last updated
12/11/2017
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