Provider First Line Business Practice Location Address:
821 LIBERTY ST E STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29745-2239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-818-5578
Provider Business Practice Location Address Fax Number:
803-818-5887
Provider Enumeration Date:
06/13/2005