Provider First Line Business Practice Location Address:
710 S CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTANBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29306-5345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-230-6479
Provider Business Practice Location Address Fax Number:
864-578-7176
Provider Enumeration Date:
07/02/2006