Provider First Line Business Practice Location Address:
114 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HEATH SPRINGS
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-273-9336
Provider Business Practice Location Address Fax Number:
803-273-3202
Provider Enumeration Date:
01/19/2007