Provider First Line Business Practice Location Address:
1226 U.S. HIGHWAY 321 BY PASS SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINNSBORO
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29180-0622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-635-4607
Provider Business Practice Location Address Fax Number:
803-635-4825
Provider Enumeration Date:
11/30/2006