Provider First Line Business Practice Location Address:
600 N WHEELER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROSPERITY
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-364-4852
Provider Business Practice Location Address Fax Number:
803-364-2014
Provider Enumeration Date:
12/23/2005