Provider First Line Business Practice Location Address:
388 E. COLUMBIA AVE.
Provider Second Line Business Practice Location Address:
STE.B
Provider Business Practice Location Address City Name:
BATESBURG-LEESVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29070-9285
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-532-1580
Provider Business Practice Location Address Fax Number:
803-532-3832
Provider Enumeration Date:
09/08/2009