Registry details
Type
Individual
Primary specialty
Internal Medicine
Enumerated
Jul 10, 2006
License(s)
18932 (SC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1205 N MAIN ST | Marion, SC 29571-2008 | 843-423-0760 |
| MAILING | PO BOX 603898 | Charlotte, NC 28260-3898 | 843-423-0760 |
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