Provider First Line Business Practice Location Address:
1 WELLNESS BLVD.
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
IRMO
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-749-0808
Provider Business Practice Location Address Fax Number:
803-749-0308
Provider Enumeration Date:
08/11/2010