Provider First Line Business Practice Location Address:
2482 POWELL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-527-7533
Provider Business Practice Location Address Fax Number:
843-527-7940
Provider Enumeration Date:
03/15/2007