Provider First Line Business Practice Location Address:
145 N CHURCH ST
Provider Second Line Business Practice Location Address:
BTC #66
Provider Business Practice Location Address City Name:
SPARTANBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29306-5123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-591-2322
Provider Business Practice Location Address Fax Number:
864-591-2323
Provider Enumeration Date:
07/16/2008