Provider First Line Business Practice Location Address:
1170 PLOWDEN MILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMTER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29153-9295
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-565-7973
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2026