Provider First Line Business Practice Location Address: 
200 MCGEE RD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
ANDERSON
    Provider Business Practice Location Address State Name: 
SC
    Provider Business Practice Location Address Postal Code: 
29625-2104
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
864-260-2220
    Provider Business Practice Location Address Fax Number: 
864-260-2225
    Provider Enumeration Date: 
10/04/2012