Provider First Line Business Practice Location Address:
215 N MAGNOLIA 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:
29150-4943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-775-9364
Provider Business Practice Location Address Fax Number:
803-773-6615
Provider Enumeration Date:
09/25/2007