Provider First Line Business Practice Location Address:
464-B NW 72 BYPASS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENWOOD
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-943-1143
Provider Business Practice Location Address Fax Number:
864-943-2066
Provider Enumeration Date:
02/02/2009