Provider First Line Business Practice Location Address:
550 S CHURCH ST STE 4
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:
29306-3306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-774-7001
Provider Business Practice Location Address Fax Number:
864-499-3742
Provider Enumeration Date:
08/25/2006