Provider First Line Business Practice Location Address:
184 OAKLAND AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTANBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29302-1669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-582-8570
Provider Business Practice Location Address Fax Number:
864-585-3528
Provider Enumeration Date:
06/27/2006