Provider First Line Business Practice Location Address:
8650 ASHEVILLE HWY
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:
29316-4606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-578-6243
Provider Business Practice Location Address Fax Number:
864-578-4720
Provider Enumeration Date:
07/29/2006