Provider First Line Business Practice Location Address:
300 S MAIN ST
Provider Second Line Business Practice Location Address:
FOUNTAIN INN FAMILY PRACTICE
Provider Business Practice Location Address City Name:
FOUNTAIN INN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29644-1931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-862-3471
Provider Business Practice Location Address Fax Number:
864-862-2444
Provider Enumeration Date:
10/04/2006