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1205987419
JONATHAN L DIETER
CONWAY, SC
NPI
1205987419
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
207Q00000X Family Medicine
(Licence: SC 7055)
Enumeration Date
2007-01-15
Last Update Date
2007-10-10
Business Address
-- JONATHAN L DIETER MD
8014 MYRTLE TRACE DR
CONWAY, SC 29526-8945
Phone number: 843-347-7224
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Mailing Address
-- JONATHAN L DIETER MD
8014 MYRTLE TRACE DR
CONWAY, SC 29526-8945
Phone number: 843-347-7224
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