Provider First Line Business Practice Location Address:
128 BEEF JERKY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGEBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-531-2966
Provider Business Practice Location Address Fax Number:
803-534-2448
Provider Enumeration Date:
02/16/2007