Provider First Line Business Practice Location Address:
4545 HWY 17 BYPASS
Provider Second Line Business Practice Location Address:
STE. A
Provider Business Practice Location Address City Name:
MURRELLS INLET
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-652-5344
Provider Business Practice Location Address Fax Number:
843-652-0067
Provider Enumeration Date:
10/05/2005