Provider First Line Business Practice Location Address:
1302 HWY 72-221 EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENWOOD
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-223-1891
Provider Business Practice Location Address Fax Number:
864-223-4144
Provider Enumeration Date:
09/12/2012