Provider First Line Business Practice Location Address:
943 N CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTANBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29303-2712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-585-2214
Provider Business Practice Location Address Fax Number:
864-585-5608
Provider Enumeration Date:
03/01/2007