Provider First Line Business Practice Location Address:
135 RUTLEDGE ST
Provider Second Line Business Practice Location Address:
ROOM 911
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29425-8903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-876-1390
Provider Business Practice Location Address Fax Number:
843-876-0678
Provider Enumeration Date:
09/02/2005