Provider First Line Business Practice Location Address:
103 S MAIN ST
Provider Second Line Business Practice Location Address:
HEALTHCARE PLACE AT BETHUNE
Provider Business Practice Location Address City Name:
BETHUNE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-334-6551
Provider Business Practice Location Address Fax Number:
843-334-6583
Provider Enumeration Date:
09/20/2005