Provider First Line Business Practice Location Address:
211 NORTH WASHINGTON ST
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:
29150-4204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-775-9314
Provider Business Practice Location Address Fax Number:
803-773-8381
Provider Enumeration Date:
04/25/2007