Provider First Line Business Practice Location Address:
29 BEE ST 4TH FLOOR (ORTHODONTICS DEPARTMENT)
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:
29425-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-288-6790
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2023