Provider First Line Business Practice Location Address:
450 E KENNEDY ST
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:
29302-1916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-585-4564
Provider Business Practice Location Address Fax Number:
864-585-5614
Provider Enumeration Date:
03/22/2006