Provider First Line Business Practice Location Address:
173 ASHLEY AVE
Provider Second Line Business Practice Location Address:
ROOM 544 BSB, DIVISION OF ORAL PATHOLOGY, MUSC
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29425-5070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-792-4495
Provider Business Practice Location Address Fax Number:
843-792-3697
Provider Enumeration Date:
10/18/2006