Organization
PRIMECARE OF THE LOWER PEE DEE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYRONE D WALLACE (OWNER/PROVIDER)
(843) 394-8274
Entity
Organization
Contact information
Practice address
263 KELLEY ST, STE 100, LAKE CITY, SC 29560-2472
(843) 394-8274
(843) 394-1604
Mailing address
263 KELLEY ST, STE 100, LAKE CITY, SC 29560-2472
(843) 394-8274
(843) 394-1604
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
SC
Other
Enumeration date
03/14/2017
Last updated
03/14/2017
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