Provider First Line Business Practice Location Address:
2224 OLD FURNACE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTANBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-578-8720
Provider Business Practice Location Address Fax Number:
864-599-5678
Provider Enumeration Date:
07/12/2006