Provider First Line Business Practice Location Address:
113 WAPPOO CREEK DRIVE SUITE 5
Provider Second Line Business Practice Location Address:
JAMES ISLAND DENTAL ASSOCIATES PA
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
873-762-1234
Provider Business Practice Location Address Fax Number:
843-762-9142
Provider Enumeration Date:
06/20/2013