Provider First Line Business Practice Location Address:
11631 ASHEVILLE HWY
Provider Second Line Business Practice Location Address:
SUITE I
Provider Business Practice Location Address City Name:
INMAN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29349-1812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-473-0242
Provider Business Practice Location Address Fax Number:
864-472-0373
Provider Enumeration Date:
12/05/2007