Provider First Line Business Practice Location Address:
111 W WADE HAMPTON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29650-1651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-877-4284
Provider Business Practice Location Address Fax Number:
864-877-0401
Provider Enumeration Date:
06/27/2006