Provider First Line Business Practice Location Address:
5535 PLATT SPRINGS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29073-7519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-314-9510
Provider Business Practice Location Address Fax Number:
803-314-9511
Provider Enumeration Date:
05/10/2010