Individual
EDWARD DEMOND BRACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9923 WILSON BLVD, BLYTHEWOOD, SC 29016-9022
(839) 810-8443
Mailing address
9923 WILSON BLVD, BLYTHEWOOD, SC 29016-9022
(839) 810-8443
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
0073603575
SC
Other
Enumeration date
07/17/2024
Last updated
07/17/2024
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