Provider First Line Business Practice Location Address:
101 E WOOD ST
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:
29303-3040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-585-8221
Provider Business Practice Location Address Fax Number:
864-542-9859
Provider Enumeration Date:
10/05/2005