Provider First Line Business Practice Location Address:
2029 W DEKALB ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMDEN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29020-2093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-272-9750
Provider Business Practice Location Address Fax Number:
803-424-2884
Provider Enumeration Date:
06/27/2006