Provider First Line Business Practice Location Address:
250 W WESMARK BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMTER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29150-1986
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-774-9565
Provider Business Practice Location Address Fax Number:
803-774-9564
Provider Enumeration Date:
06/19/2006