Provider First Line Business Practice Location Address:
3366 RIVERS AVE
Provider Second Line Business Practice Location Address:
CHARLESTON COUNTY DSS
Provider Business Practice Location Address City Name:
NORTH CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29405-7725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-953-9877
Provider Business Practice Location Address Fax Number:
843-740-1575
Provider Enumeration Date:
11/07/2012