Provider First Line Business Practice Location Address:
139 EDGEFIELD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH AUGUSTA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29841-2423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-434-4000
Provider Business Practice Location Address Fax Number:
706-396-2100
Provider Enumeration Date:
01/25/2011