Provider First Line Business Practice Location Address:
121 LIPMAN 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:
29483-3673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-901-0182
Provider Business Practice Location Address Fax Number:
843-875-7116
Provider Enumeration Date:
07/21/2008