Provider First Line Business Practice Location Address:
155 RIDGE MEDICAL PLAZA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDGEFIELD
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29824-4531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-637-3146
Provider Business Practice Location Address Fax Number:
803-637-6597
Provider Enumeration Date:
08/20/2006