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1053310516
TERRY LEE CLARK
CHARLESTON, SC
NPI
1053310516
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363AS0400X Physician Assistant, Surgical
(Licence: SC A475)
Enumeration Date
2005-07-18
Last Update Date
2008-02-04
Business Address
Mr. TERRY LEE CLARK PA-C
109 BEE ST
CHARLESTON, SC 29401-5703
Phone number: 843-789-7330
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Mailing Address
Mr. TERRY LEE CLARK PA-C
5711 CAPTAIN KIDD RD
HOLLYWOOD, SC 29449-6803
Phone number: 843-696-4290
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