Provider First Line Business Practice Location Address:
215 E 5TH NORTH ST
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:
29483-6823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-873-2225
Provider Business Practice Location Address Fax Number:
843-406-9743
Provider Enumeration Date:
10/05/2006