Provider First Line Business Practice Location Address:
117 W CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATESBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29006-2108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-532-9870
Provider Business Practice Location Address Fax Number:
803-532-1259
Provider Enumeration Date:
10/19/2005