Provider First Line Business Practice Location Address:
9313 MEDICAL PLAZA DR
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
N CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29406-7140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-553-7615
Provider Business Practice Location Address Fax Number:
843-553-1008
Provider Enumeration Date:
04/27/2006