Provider First Line Business Practice Location Address:
1275 PEACH ORCHARD RD STE B
Provider Second Line Business Practice Location Address:
1275 PEACH ORCHARD ROAD, SUITE B
Provider Business Practice Location Address City Name:
SUMTER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29154-1356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-494-2590
Provider Business Practice Location Address Fax Number:
803-494-8998
Provider Enumeration Date:
08/24/2009