Portereshice Shunta Brabham
NPI #1528309606 in Fairfax, South Carolina
Provider Information
- NPI Number
- 1528309606
- Entity Type
- Individual
- Name
- Portereshice Shunta Brabham
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Health Maintenance Organization
- Enumeration Date
- Mar 14, 2013
- Last Updated
- Mar 14, 2013
Practice Location
- Address
- 345 AMELIA ST
- City
- Fairfax
- State
- South Carolina
- ZIP Code
- 29827-5967
- Phone
- (803) 682-7110
Specialties & Taxonomy Codes
| Specialty |
|---|
| Health Maintenance Organization |
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