Provider First Line Business Practice Location Address:
THE BLAKE AT EDGEWATER
Provider Second Line Business Practice Location Address:
1099 EDGEWATER CORPORATE PARKWAY
Provider Business Practice Location Address City Name:
INDIAN LAND
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-833-0077
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/23/2018