Provider First Line Business Practice Location Address:
1278 N LAFAYETTE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMTER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29150-2964
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-774-4500
Provider Business Practice Location Address Fax Number:
803-774-4641
Provider Enumeration Date:
05/11/2006