Provider First Line Business Practice Location Address:
VA MYRTLE BEACH PRIMARY CARE CLINIC
Provider Second Line Business Practice Location Address:
3381 PHILLIS BOULEVARD
Provider Business Practice Location Address City Name:
MYRTLE BEACH
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29577
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-477-0177
Provider Business Practice Location Address Fax Number:
843-828-0338
Provider Enumeration Date:
08/17/2006