Provider First Line Business Practice Location Address:
11015 ELLENTON STREET, HIGHWAY 278
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARNWELL
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-541-1061
Provider Business Practice Location Address Fax Number:
803-541-1066
Provider Enumeration Date:
10/18/2006