Provider First Line Business Practice Location Address:
1012 ANNA KNAPP EXT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29464-5400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-696-7920
Provider Business Practice Location Address Fax Number:
843-884-0061
Provider Enumeration Date:
01/28/2013