Provider First Line Business Practice Location Address:
1033 EDGEFIELD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENWOOD
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29646-3205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-227-3908
Provider Business Practice Location Address Fax Number:
864-227-2668
Provider Enumeration Date:
07/07/2009