Provider First Line Business Practice Location Address:
AGAPE SENIOR PRIMARY CARE INC DBA MAIN STREET PHYSICIAN
Provider Second Line Business Practice Location Address:
3612 MITCHELL STREET
Provider Business Practice Location Address City Name:
LORIS
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-756-2122
Provider Business Practice Location Address Fax Number:
843-756-2121
Provider Enumeration Date:
05/24/2010