Provider First Line Business Practice Location Address:
635 S HAZARD 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:
29440-4728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-249-1781
Provider Business Practice Location Address Fax Number:
360-364-3499
Provider Enumeration Date:
04/01/2006