Provider First Line Business Practice Location Address:
24 MEMORIAL MEDICAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29605-4452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-295-4160
Provider Business Practice Location Address Fax Number:
864-295-0445
Provider Enumeration Date:
03/16/2006