Provider First Line Business Practice Location Address:
1010 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:
843-971-1920
Provider Business Practice Location Address Fax Number:
843-971-1920
Provider Enumeration Date:
02/15/2010