Provider First Line Business Practice Location Address:
12890 COUNTY LINE RD
Provider Second Line Business Practice Location Address:
ANDREWS HIGH SCHOOL
Provider Business Practice Location Address City Name:
ANDREWS
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29510-6877
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-264-3414
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2014