Provider First Line Business Practice Location Address:
147 OAKWOOD AVE
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:
29302-1207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-582-8135
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/31/2006