Provider First Line Business Practice Location Address:
1101 CHURCH ST
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:
29440-3201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-520-0300
Provider Business Practice Location Address Fax Number:
843-520-0301
Provider Enumeration Date:
08/10/2005