Provider First Line Business Practice Location Address: 
1120 TIMMONSVILLE HWY
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
DARLINGTON
    Provider Business Practice Location Address State Name: 
SC
    Provider Business Practice Location Address Postal Code: 
29532-9998
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
843-393-8600
    Provider Business Practice Location Address Fax Number: 
843-393-6471
    Provider Enumeration Date: 
04/17/2013