Provider First Line Business Practice Location Address:
100 RIDGE MEDICAL PLAZA
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
EDGEFIELD
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-637-5757
Provider Business Practice Location Address Fax Number:
803-637-9996
Provider Enumeration Date:
11/26/2007