Provider First Line Business Practice Location Address:
2421 HIGHWAY 17 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
N MYRTLE BEACH
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29582-4343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-272-7979
Provider Business Practice Location Address Fax Number:
843-272-3534
Provider Enumeration Date:
08/01/2005