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1679786313
STACEY RENA VANDALL
MYRTLE BEACH, SC
NPI
1679786313
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
225200000X Physical Therapy Assistant
(Licence: SC 1504)
Enumeration Date
2007-05-08
Last Update Date
2016-09-30
Business Address
MISS STACEY RENA VANDALL PTA
455 SUNNEHANNA DR BOX 384
MYRTLE BEACH, SC 29588-5365
Phone number: 843-340-4478
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Mailing Address
MISS STACEY RENA VANDALL PTA
455 SUNNEHANNA DR BOX 384
MYRTLE BEACH, SC 29588-5365
Phone number: 843-340-4478
Copy
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