Provider First Line Business Practice Location Address:
2229 OLD GREENVILLE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENDLETON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-855-1036
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/22/2005