Provider First Line Business Practice Location Address:
800 LAFAYETTE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMDEN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29020-3406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-713-8350
Provider Business Practice Location Address Fax Number:
803-713-8433
Provider Enumeration Date:
12/29/2005