Provider First Line Business Practice Location Address:
9017 STATE HIGHWAY 215 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JENKINSVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29065-9428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-298-2068
Provider Business Practice Location Address Fax Number:
803-298-2069
Provider Enumeration Date:
04/25/2007