Provider First Line Business Practice Location Address:
803 HIGHWAY 15-401 BYPASS WEST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENNETTSVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-479-3281
Provider Business Practice Location Address Fax Number:
843-479-5446
Provider Enumeration Date:
01/31/2007