Provider First Line Business Practice Location Address:
2237 HIGHWAY 9 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONGS
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29568-5701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-399-9965
Provider Business Practice Location Address Fax Number:
843-399-9974
Provider Enumeration Date:
08/14/2006