Provider First Line Business Practice Location Address:
1649 US HWY 52
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCRANTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29591-0129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-389-2531
Provider Business Practice Location Address Fax Number:
843-389-2548
Provider Enumeration Date:
05/20/2013