Provider First Line Business Practice Location Address:
930 OSWEGO HWY
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:
29153-8733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-775-4281
Provider Business Practice Location Address Fax Number:
803-778-2167
Provider Enumeration Date:
02/07/2007