Provider First Line Business Practice Location Address:
905 W DEKALB STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMDER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29020-4259
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-424-0165
Provider Business Practice Location Address Fax Number:
803-425-0161
Provider Enumeration Date:
04/23/2007