Provider First Line Business Practice Location Address:
120 W CHURCH ST
Provider Second Line Business Practice Location Address:
STE. E
Provider Business Practice Location Address City Name:
BATESBURG-LEESVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29006-2107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-532-2208
Provider Business Practice Location Address Fax Number:
803-604-0207
Provider Enumeration Date:
03/16/2006