Provider First Line Business Practice Location Address:
OTOLARYNGOLOGY HEAD AND NECK SURGERY
Provider Second Line Business Practice Location Address:
135 RUTLEDGE AVE MSC 550
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29425-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-792-1414
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/21/2012