Provider First Line Business Practice Location Address:
1300 HAILE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMDEN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29020-3002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-254-3278
Provider Business Practice Location Address Fax Number:
803-255-2715
Provider Enumeration Date:
07/10/2006