Provider First Line Business Practice Location Address:
1530 HIGHMARKET 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:
29440-3121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-833-8006
Provider Business Practice Location Address Fax Number:
843-833-8014
Provider Enumeration Date:
02/10/2026