Provider First Line Business Practice Location Address:
2221 SAINT MATTHEWS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGEBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29118-2040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-534-3324
Provider Business Practice Location Address Fax Number:
803-534-8303
Provider Enumeration Date:
01/17/2008