Provider First Line Business Practice Location Address:
411B N. SALEM AVENUE
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:
29151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-774-2103
Provider Business Practice Location Address Fax Number:
803-774-2105
Provider Enumeration Date:
03/22/2007