Provider First Line Business Practice Location Address:
408 E DEKALB ST
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
CAMDEN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29020-4429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-272-0990
Provider Business Practice Location Address Fax Number:
803-272-0991
Provider Enumeration Date:
08/25/2006