Most Relevant Information
Provider Data
| NPI Number: | 1003294760 |
| Provider Name: | MARTHA MONTGOMERY |
| Entity Type: | Individual |
| Taxonomy Code: | 261QA0600X |
| Specialty: | Clinic/Center |
| License Number: | 261QA0600X |
Most Important Dates
| Enumeration Date: | 05/14/2015 |
| Last Updated: | 05/14/2015 |
Provider Practice Location
112 W FARIS RD
GREENVILLE
SC
296053061
Practice Location Phone/Fax
| Phone: | 4042900296 |
| Fax: |
Provider Mailing Location
112 W FARIS RD
GREENVILLE
SC
296053061
Provider Mailing Phone/Fax
| Phone: | 4042900296 |
| Fax: |