Provider First Line Business Practice Location Address:
705 HAILE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMTER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29150-3143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-983-4544
Provider Business Practice Location Address Fax Number:
803-983-4544
Provider Enumeration Date:
02/05/2007