Provider First Line Business Practice Location Address:
2039 W DEKALB ST
Provider Second Line Business Practice Location Address:
BUILDING 1, SUITE 2
Provider Business Practice Location Address City Name:
CAMDEN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29020-2092
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-432-5200
Provider Business Practice Location Address Fax Number:
803-432-5199
Provider Enumeration Date:
11/13/2006