Provider First Line Business Practice Location Address:
10820 N KINGS HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MYRTLE BEACH
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-467-2060
Provider Business Practice Location Address Fax Number:
843-692-3094
Provider Enumeration Date:
12/14/2006