Provider First Line Business Practice Location Address:
67 PRESIDENT ST, MSC 861
Provider Second Line Business Practice Location Address:
MEDICAL UNIVERSITY OF SC
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-792-7267
Provider Business Practice Location Address Fax Number:
843-792-3187
Provider Enumeration Date:
05/17/2006