LAKE MARION PRIMARY CARE
Osteopathic Medicine at Hospital St, Foreston, SC

License number
South Carolina 13275
Category
Osteopathic Medicine
Type
Family Medicine
License number
South Carolina 20345
Category
Osteopathic Medicine
Type
Cardiovascular Disease
Owner
Name: SAUNDRA WALLACE
Title: ADMINISTRATOR
Phone: (803) 435-2529
Address
Address
15 E Hospital St, Foreston, SC 29102
National Provider ID: 1912964479
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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Lake Marion Primary Care

15 E Hospital St, Manning, SC 29102

Status:
Inactive
Doing business as:
LAKE MARION PRIMARY CARE, INC
Registration:
Jul 8, 1996
Business type:
Domestic
Formation place:
SOUTH CAROLINA
Expiration:
11/19/1998
Agent:
Edward C Keith

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