Provider First Line Business Practice Location Address:
300 RIDGE MEDICAL PLAZA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDGEFIELD
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29824-0590
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-637-1157
Provider Business Practice Location Address Fax Number:
803-637-0200
Provider Enumeration Date:
10/19/2006