Provider First Line Business Practice Location Address:
601 W MAIN 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:
29301-2105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-270-2753
Provider Business Practice Location Address Fax Number:
864-542-2324
Provider Enumeration Date:
12/08/2006