Organization
AEDIABETIC3
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALICE DENISE ETHEREDGE (DIABETIC CONSULTANT)
(803) 520-8117
Entity
Organization
Contact information
Practice address
300 PALMETTO PARK BLVD APT 309, LEXINGTON, SC 29072-7877
(803) 520-8117
(803) 520-8117
Mailing address
300 PALMETTO PARK BLVD APT 309, LEXINGTON, SC 29072-7877
(803) 520-8117
(803) 520-8117
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
06/12/2009
Last updated
06/12/2009
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