Provider First Line Business Practice Location Address:
2126 E HWY 9
Provider Second Line Business Practice Location Address:
PARKWAY PLAZA CENTER BLDG G STE 4
Provider Business Practice Location Address City Name:
LONGS
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-399-7002
Provider Business Practice Location Address Fax Number:
843-399-7045
Provider Enumeration Date:
03/26/2007