Provider First Line Business Practice Location Address:
4741 HIGHWAY 153 STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASLEY
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29642-9161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-991-8414
Provider Business Practice Location Address Fax Number:
864-991-8404
Provider Enumeration Date:
01/31/2012