Provider First Line Business Practice Location Address:
2605 KINARD STREET
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
NEWBERRY
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29108-2909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-276-4860
Provider Business Practice Location Address Fax Number:
803-276-2812
Provider Enumeration Date:
09/20/2006