Provider First Line Business Practice Location Address:
500 THURGOOD MARSHALL HWY STE G
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSTREE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29556-4143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-355-0180
Provider Business Practice Location Address Fax Number:
843-355-1606
Provider Enumeration Date:
09/26/2012