Provider First Line Business Practice Location Address:
9239 MEDICAL PLAZA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29406-9126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-797-5151
Provider Business Practice Location Address Fax Number:
843-572-6939
Provider Enumeration Date:
11/01/2011