Provider First Line Business Practice Location Address:
134 GARNER RD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTANBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29303-3132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-327-1487
Provider Business Practice Location Address Fax Number:
864-327-1491
Provider Enumeration Date:
08/04/2006