Provider First Line Business Practice Location Address:
115 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:
29302-1531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-574-2011
Provider Business Practice Location Address Fax Number:
864-576-7377
Provider Enumeration Date:
02/28/2007