Provider First Line Business Practice Location Address:
200 E HOSPITAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANNING
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29102-3160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-433-0439
Provider Business Practice Location Address Fax Number:
803-433-9840
Provider Enumeration Date:
06/20/2005