Provider First Line Business Practice Location Address:
45 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARE SHOALS
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29692-1440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-456-2711
Provider Business Practice Location Address Fax Number:
864-456-4470
Provider Enumeration Date:
12/20/2006