Provider First Line Business Practice Location Address:
4201 CAROLINA EXCHANGE DRIVE, SUITE 201
Provider Second Line Business Practice Location Address:
GRAND STRAND ANXIETY & OCD CENTER LLC
Provider Business Practice Location Address City Name:
MYRTLE BEACH
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29579-4395
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-543-2732
Provider Business Practice Location Address Fax Number:
843-796-1200
Provider Enumeration Date:
01/19/2007