Provider First Line Business Practice Location Address:
171 ASHLEY AVENUE, SUITE 309
Provider Second Line Business Practice Location Address:
MEDICAL UNIVERSITY OF SOUTH CAROLINA, DEPT OF PATH
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29525-8905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-792-3121
Provider Business Practice Location Address Fax Number:
843-792-3537
Provider Enumeration Date:
11/01/2006