Provider First Line Business Practice Location Address:
1327 HAILE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMDEN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29020-3001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-498-0909
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/21/2008