Individual
ANTOINE JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
757 SAXONY DR, IRMO, SC 29063-7108
(803) 445-3396
Mailing address
757 SAXONY DRIVE, IRMO, SC 29063
(803) 445-3396
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
05/26/2016
Last updated
05/26/2016
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