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1326568197
KRISTEN HENDERSON LASETA
CHARLESTON, SC
NPI
1326568197
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: SC 949)
Enumeration Date
2017-06-22
Last Update Date
2017-06-22
Business Address
KRISTEN HENDERSON LASETA ATC
4060 WILDCAT BLVD
CHARLESTON, SC 29414-5851
Phone number: 843-573-1201
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Mailing Address
KRISTEN HENDERSON LASETA ATC
507 STINSON DR APT A6
CHARLESTON, SC 29407-6239
Phone number:
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