Provider First Line Business Practice Location Address:
2000 S PINE 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:
29302-3315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-542-1426
Provider Business Practice Location Address Fax Number:
864-582-0413
Provider Enumeration Date:
07/29/2006