Provider First Line Business Practice Location Address:
9150 MEDCOM ST
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
N CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29406-7108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-572-3330
Provider Business Practice Location Address Fax Number:
843-572-1255
Provider Enumeration Date:
07/11/2005