Provider First Line Business Practice Location Address:
1301 OLD HWY. 52 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONCKS CORNER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-761-0311
Provider Business Practice Location Address Fax Number:
843-761-0303
Provider Enumeration Date:
01/29/2014