Provider First Line Business Practice Location Address: 
2300 PAMPLICO HWY
    Provider Second Line Business Practice Location Address: 
KJ'S PHARMACY 159
    Provider Business Practice Location Address City Name: 
FLORENCE
    Provider Business Practice Location Address State Name: 
SC
    Provider Business Practice Location Address Postal Code: 
29505
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
843-468-9803
    Provider Business Practice Location Address Fax Number: 
843-662-4570
    Provider Enumeration Date: 
07/13/2017