Provider First Line Business Practice Location Address:
410 E HENRY 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:
29302-2610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-583-7644
Provider Business Practice Location Address Fax Number:
864-582-0034
Provider Enumeration Date:
05/19/2006