Provider First Line Business Practice Location Address:
173 ASHLEY AVE
Provider Second Line Business Practice Location Address:
DENTAL FACULTY PRACTICE
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:
843-792-2337
Provider Business Practice Location Address Fax Number:
843-792-1593
Provider Enumeration Date:
12/29/2006