Provider First Line Business Practice Location Address:
2126 HIGHWAY 9 E STE F2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONGS
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29568-5735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-399-1650
Provider Business Practice Location Address Fax Number:
843-399-2924
Provider Enumeration Date:
06/10/2026