Provider First Line Business Practice Location Address:
815 E LIBERTY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29745-1661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-628-2728
Provider Business Practice Location Address Fax Number:
803-628-2722
Provider Enumeration Date:
06/18/2008