Individual
MISS JESSICA ALEXIS KOLLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
2 MEDICAL PARK RD, COLUMBIA, SC 29203-6808
(203) 470-1558
Mailing address
215 SPENCER PL, APT 913, CAYCE, SC 29033-3980
(203) 470-1558
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
1339
SC
Other
Enumeration date
01/05/2013
Last updated
01/05/2013
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