Provider First Line Business Practice Location Address:
2664 SAINT MATTHEWS RD STE B
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:
29118-1344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-534-6567
Provider Business Practice Location Address Fax Number:
803-937-6566
Provider Enumeration Date:
08/06/2012