Provider First Line Business Practice Location Address:
9330 MEDICAL PLAZA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-847-3225
Provider Business Practice Location Address Fax Number:
843-847-3247
Provider Enumeration Date:
04/27/2006