Provider First Line Business Practice Location Address:
129 N WASHINGTON ST
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:
29150-4949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-774-8877
Provider Business Practice Location Address Fax Number:
803-774-8879
Provider Enumeration Date:
03/29/2007