Provider First Line Business Practice Location Address:
238 DAWHOO LAKE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29440-8720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-264-2911
Provider Business Practice Location Address Fax Number:
843-264-2604
Provider Enumeration Date:
05/02/2006