Provider First Line Business Practice Location Address:
1776 WILLIAM KENNERTY DRIVE
Provider Second Line Business Practice Location Address:
WEST ASHLEY MIDDLE SCHOOL
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-852-6536
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/24/2013