Provider First Line Business Practice Location Address:
111 POWELL MILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTANBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29301-1531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-574-4590
Provider Business Practice Location Address Fax Number:
864-587-7458
Provider Enumeration Date:
01/06/2006