Provider First Line Business Practice Location Address:
628TH MEDICAL GROUP
Provider Second Line Business Practice Location Address:
204 WEST HILL BLVD
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-571-5000
Provider Business Practice Location Address Fax Number:
804-518-1314
Provider Enumeration Date:
07/21/2010