Provider First Line Business Practice Location Address:
137 EAST 2ND NORTH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMMERVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29483
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-871-7003
Provider Business Practice Location Address Fax Number:
843-871-0882
Provider Enumeration Date:
10/11/2006