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1023401890
LARISA DIFFLEY
CHARLESTON, SC
NPI
1023401890
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: SC 2200)
Enumeration Date
2015-03-18
Last Update Date
2015-03-18
Business Address
-- LARISA DIFFLEY
171 ASHLEY AVE
CHARLESTON, SC 29425-8908
Phone number: 843-792-1414
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Mailing Address
-- LARISA DIFFLEY
PO BOX 751461
CHARLOTTE, NC 28275-1461
Phone number: 843-792-6200
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