Provider First Line Business Practice Location Address:
887 EAST LIBERTY STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-684-3358
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/02/2010