Provider First Line Business Practice Location Address:
16 BURR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARNWELL
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-259-3541
Provider Business Practice Location Address Fax Number:
803-259-3630
Provider Enumeration Date:
07/11/2006