Provider First Line Business Practice Location Address:
448 N MAIN ST
Provider Second Line Business Practice Location Address:
EXCELSIOR MEDICAL CLINIC, PA
Provider Business Practice Location Address City Name:
SUMTER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29150-4233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-778-2429
Provider Business Practice Location Address Fax Number:
803-773-6303
Provider Enumeration Date:
05/19/2006