Provider First Line Business Practice Location Address:
141 E CHURCH ST STE N
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:
29070-7066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-532-3335
Provider Business Practice Location Address Fax Number:
803-532-3337
Provider Enumeration Date:
12/16/2008