Provider First Line Business Practice Location Address:
215 FOLK STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDGEFIELD
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-275-7780
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/03/2026