Provider First Line Business Practice Location Address:
2020 HIGHMARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29440-2618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-436-1333
Provider Business Practice Location Address Fax Number:
843-436-1335
Provider Enumeration Date:
05/03/2007