Provider First Line Business Practice Location Address:
173 ASHLEY AVE RM 440 BSB
Provider Second Line Business Practice Location Address:
MUSC - ENDODONTICS
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29425-8908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-792-3516
Provider Business Practice Location Address Fax Number:
843-792-6433
Provider Enumeration Date:
04/20/2007