Provider First Line Business Practice Location Address:
237 S GEORGETOWN HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSONVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29555-8081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-386-2609
Provider Business Practice Location Address Fax Number:
843-386-3125
Provider Enumeration Date:
01/18/2013