Individual
MADISON ROSE LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2221 MEADOWOOD LN, LONGS, SC 29568-6516
(843) 877-1801
Mailing address
2221 MEADOWOOD LN, LONGS, SC 29568-6516
(843) 877-1801
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
06/25/2021
Last updated
06/25/2021
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