Provider First Line Business Practice Location Address:
105 N YORK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29720-2064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-286-6424
Provider Business Practice Location Address Fax Number:
803-286-6523
Provider Enumeration Date:
10/19/2006