Provider First Line Business Practice Location Address:
219 CHURCH 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:
29440-2403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-545-5188
Provider Business Practice Location Address Fax Number:
843-520-4864
Provider Enumeration Date:
04/22/2009