Provider First Line Business Practice Location Address:
809 82ND PARKWAY
Provider Second Line Business Practice Location Address:
GRAND STAND REGIONAL MEDICAL CENTER
Provider Business Practice Location Address City Name:
MYRTLE BEACH
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-692-1750
Provider Business Practice Location Address Fax Number:
954-851-1746
Provider Enumeration Date:
01/28/2011