Provider First Line Business Practice Location Address:
67 PRESIDENT ST
Provider Second Line Business Practice Location Address:
INSTITUTE OF PSYCHIATRY, 5 SOUTH
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29425-5712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-792-0195
Provider Business Practice Location Address Fax Number:
843-792-4190
Provider Enumeration Date:
08/29/2006