Individual
DIANA M BRUNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
712 BULTMAN DR, STE A, SUMTER, SC 29150-2553
(803) 774-2639
Mailing address
2630 TURNINGLEAF LN, DALZELL, SC 29040
(803) 499-6744
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS6459
SC
Other
Enumeration date
05/26/2010
Last updated
05/26/2010
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