Provider First Line Business Practice Location Address:
115 N HARVIN ST FL 6
Provider Second Line Business Practice Location Address:
SC DEPARTMENT OF JUVENILE JUSTICE
Provider Business Practice Location Address City Name:
SUMTER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29150-4956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-778-2368
Provider Business Practice Location Address Fax Number:
803-775-2377
Provider Enumeration Date:
12/12/2012