Provider First Line Business Practice Location Address:
1670 DRYDOCK AVE
Provider Second Line Business Practice Location Address:
BLDG 10A DETYENS MEDICAL CENTER
Provider Business Practice Location Address City Name:
NORTH CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-747-3193
Provider Business Practice Location Address Fax Number:
843-747-3194
Provider Enumeration Date:
11/08/2006