Provider First Line Business Practice Location Address:
1240 HIGHWAY 17 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH MYRTLE BEACH
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29582-3707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-663-1013
Provider Business Practice Location Address Fax Number:
843-663-1017
Provider Enumeration Date:
02/13/2008