Provider First Line Business Practice Location Address:
379 E KENNEDY 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:
29304-5863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-585-2299
Provider Business Practice Location Address Fax Number:
864-542-0587
Provider Enumeration Date:
11/07/2006