Provider First Line Business Practice Location Address:
3605 HIGHMARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29440-4651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-545-3271
Provider Business Practice Location Address Fax Number:
843-545-3646
Provider Enumeration Date:
01/24/2007