Provider First Line Business Practice Location Address:
15 E HOSPITAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANNING
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29102-3152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-435-2529
Provider Business Practice Location Address Fax Number:
803-435-4196
Provider Enumeration Date:
04/03/2006