Provider First Line Business Practice Location Address:
21 E HOSPITAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANNING
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29102-3152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-883-5171
Provider Business Practice Location Address Fax Number:
38-435-5288
Provider Enumeration Date:
03/31/2006