Provider First Line Business Practice Location Address:
351 S. MIDWAY HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSONVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-380-0777
Provider Business Practice Location Address Fax Number:
843-380-1531
Provider Enumeration Date:
04/05/2011