Provider First Line Business Practice Location Address:
5535 PLATT SPRINGS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29073-7519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-951-1880
Provider Business Practice Location Address Fax Number:
803-951-0384
Provider Enumeration Date:
10/04/2006