| NPI | 1780677682 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE H WELLMON Dpm 864-487-5516 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: SC 86) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NC 216) |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2022-08-29 |