Provider First Line Business Practice Location Address:
124 HILLBROOK DRIVE (NOTE: RECEIVE PRACTICE MAIL HERE)
Provider Second Line Business Practice Location Address:
(SEE PTS AT HOME &AT CH OFFS- SP'BURG & GAFFNEY, SC)
Provider Business Practice Location Address City Name:
SPARTANBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29307-3040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-978-7166
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/04/2006