Provider First Line Business Practice Location Address:
2503 HIGHMARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29440-2900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-546-1730
Provider Business Practice Location Address Fax Number:
843-839-2367
Provider Enumeration Date:
05/05/2006