Provider First Line Business Practice Location Address:
146 JUDGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARLEYVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-462-7355
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/06/2007