Provider First Line Business Practice Location Address:
949 ORANGEBURG RD.
Provider Second Line Business Practice Location Address:
STE. C
Provider Business Practice Location Address City Name:
SUMMERVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29483
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-900-7006
Provider Business Practice Location Address Fax Number:
843-771-3526
Provider Enumeration Date:
08/17/2006