Individual
MELISA RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
119 N CONGRESS ST, WINNSBORO, SC 29180-1118
(803) 712-3322
Mailing address
212 CHATHAM CIR, WINNSBORO, SC 29180-2607
(803) 718-3609
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
6267
SC
Other
Enumeration date
01/10/2019
Last updated
01/10/2019
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