Provider First Line Business Practice Location Address:
128 N CONGRESS ST
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29745-1547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-628-5952
Provider Business Practice Location Address Fax Number:
803-628-5953
Provider Enumeration Date:
07/22/2006