Provider First Line Business Practice Location Address:
130 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTANBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29306-5113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-327-1162
Provider Business Practice Location Address Fax Number:
864-573-9107
Provider Enumeration Date:
08/11/2010