Provider First Line Business Practice Location Address:
157 B S GREENWOOD AVE EXT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARE SHOALS
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29692
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-456-3447
Provider Business Practice Location Address Fax Number:
864-725-4979
Provider Enumeration Date:
08/07/2006