Provider First Line Business Practice Location Address:
4222 HIGHWAY 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOILING SPRINGS
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29316-6004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-814-2222
Provider Business Practice Location Address Fax Number:
864-814-2209
Provider Enumeration Date:
11/22/2005