Provider First Line Business Practice Location Address:
2020 N CHURCH STREET PL
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:
29303-2706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-582-3447
Provider Business Practice Location Address Fax Number:
864-582-3449
Provider Enumeration Date:
07/21/2005