Provider First Line Business Practice Location Address:
53 IRVING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARNWELL
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29812-1535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-259-1193
Provider Business Practice Location Address Fax Number:
803-259-1271
Provider Enumeration Date:
12/17/2009