Provider First Line Business Practice Location Address:
131 E HAMPTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMTER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29150-4929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-436-2445
Provider Business Practice Location Address Fax Number:
803-436-2485
Provider Enumeration Date:
08/24/2005