Provider First Line Business Practice Location Address:
121 NORTH PINE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATESBURG LEESVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-532-6146
Provider Business Practice Location Address Fax Number:
803-532-5807
Provider Enumeration Date:
01/11/2007