Individual
JOHN FRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
209 REDINGTON WAY, IRMO, SC 29063-8014
(803) 397-4044
Mailing address
209 REDINGTON WAY, IRMO, SC 29063-8014
(803) 397-4044
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
222920
SC
Other
Enumeration date
11/25/2016
Last updated
11/25/2016
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