Provider First Line Business Practice Location Address:
5036 CAROLINA HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENMARK
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29042-1678
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-793-3804
Provider Business Practice Location Address Fax Number:
803-793-0616
Provider Enumeration Date:
10/10/2006