Provider First Line Business Practice Location Address:
9231 MEDICAL PLAZA DR STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29406-9101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-797-7700
Provider Business Practice Location Address Fax Number:
843-797-1271
Provider Enumeration Date:
05/23/2006