Provider First Line Business Practice Location Address:
MEDICAL UNIVERSITY OF SOUTH CAROLINA
Provider Second Line Business Practice Location Address:
173 ASHLEY AVE., CRI 504
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29425-2942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-730-3617
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/26/2021