Provider First Line Business Practice Location Address:
809 E LIBERTY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29745-1661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-684-5504
Provider Business Practice Location Address Fax Number:
803-684-5496
Provider Enumeration Date:
01/24/2007