Provider First Line Business Practice Location Address:
113 WAPPOO CREEK DR. SUITE #5
Provider Second Line Business Practice Location Address:
JAMES ISLAND DENTAL ASSOCIATES
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29412-2136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-762-1234
Provider Business Practice Location Address Fax Number:
843-762-9142
Provider Enumeration Date:
03/15/2018