Provider First Line Business Practice Location Address:
764 W LIBERTY ST
Provider Second Line Business Practice Location Address:
ONE MEDICAL COURT
Provider Business Practice Location Address City Name:
SUMTER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29150-4748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-775-3694
Provider Business Practice Location Address Fax Number:
803-773-7544
Provider Enumeration Date:
10/05/2006