Provider First Line Business Practice Location Address:
9150 MEDCOM ST. STE B
Provider Second Line Business Practice Location Address:
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-871-4006
Provider Business Practice Location Address Fax Number:
843-871-4074
Provider Enumeration Date:
07/25/2007