Provider First Line Business Practice Location Address:
125 POWELL MILL RD
Provider Second Line Business Practice Location Address:
STE. C
Provider Business Practice Location Address City Name:
SPARTANBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29301-1531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-574-0788
Provider Business Practice Location Address Fax Number:
864-576-5359
Provider Enumeration Date:
05/24/2007