Provider First Line Business Practice Location Address:
21 S WASHINGTON ST
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:
29150-5159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-773-4760
Provider Business Practice Location Address Fax Number:
409-654-2068
Provider Enumeration Date:
07/11/2006