Provider First Line Business Practice Location Address:
109 BEE STREET
Provider Second Line Business Practice Location Address:
DENTAL SERVICE 160
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-789-6161
Provider Business Practice Location Address Fax Number:
843-789-6014
Provider Enumeration Date:
09/26/2006