PORTERESHICE SHUNTA BRABHAM

FAIRFAX, SC
NPI1528309606
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy302R00000X Health Maintenance Organization
Enumeration Date2013-03-14
Last Update Date2013-03-14
Business Address
-- PORTERESHICE SHUNTA BRABHAM
345 AMELIA ST
FAIRFAX, SC 29827-5967
Phone number: 803-682-7110
Mailing Address
-- PORTERESHICE SHUNTA BRABHAM
345 AMELIA ST
FAIRFAX, SC 29827-5967
Phone number: 803-682-7110