Provider First Line Business Practice Location Address:
228 E MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARNWELL
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29812-1529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-709-7778
Provider Business Practice Location Address Fax Number:
803-709-7781
Provider Enumeration Date:
01/03/2012