Provider First Line Business Practice Location Address:
15 CENTER SPRING ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDGEFIELD
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-637-5326
Provider Business Practice Location Address Fax Number:
803-637-4015
Provider Enumeration Date:
08/19/2008