Provider First Line Business Practice Location Address:
237 S. GEORGETOWN HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSONVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
834-386-2609
Provider Business Practice Location Address Fax Number:
834-386-9058
Provider Enumeration Date:
11/03/2006