Provider First Line Business Practice Location Address:
1514 E ALEXANDER LOVE HWY
Provider Second Line Business Practice Location Address:
SUITE 116
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29745-7769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-628-2220
Provider Business Practice Location Address Fax Number:
802-628-2224
Provider Enumeration Date:
08/09/2011