Provider First Line Business Practice Location Address:
1126 CAMP CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-285-4368
Provider Business Practice Location Address Fax Number:
803-286-5571
Provider Enumeration Date:
05/25/2007