Provider First Line Business Practice Location Address:
2228 HARRINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWBERRY
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29108-3026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-276-0794
Provider Business Practice Location Address Fax Number:
803-276-6669
Provider Enumeration Date:
12/20/2006