Individual
MR. MARK WILLIAM MANCEBO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
429 N. CHURCH STREET, SPARTANBURG, SC 29303
(864) 597-4458
(864) 597-4484
Mailing address
608 N. BROWN BEAVER COURT, MOORE, SC 29369
(828) 399-0032
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
965
SC
Other
Enumeration date
03/11/2009
Last updated
03/11/2009
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