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1275131054
ETHAN BRODY CLONTZ
CHARLESTON, SC
NPI
1275131054
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: SC 3574)
Enumeration Date
2020-10-13
Last Update Date
2022-05-24
Business Address
Mr. ETHAN BRODY CLONTZ PA-C
171 ASHLEY AVE
CHARLESTON, SC 29425-6483
Phone number: 843-792-1414
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Mailing Address
Mr. ETHAN BRODY CLONTZ PA-C
PO BOX 751461
CHARLOTTE, NC 28275-1461
Phone number: 843-792-6200
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