Provider First Line Business Practice Location Address:
137 MAIN ST S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLENDALE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29810-3601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-584-2151
Provider Business Practice Location Address Fax Number:
803-584-0174
Provider Enumeration Date:
03/11/2011