Provider First Line Business Practice Location Address:
425 N SALEM AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMTER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29150-4115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-773-8148
Provider Business Practice Location Address Fax Number:
803-775-5849
Provider Enumeration Date:
12/17/2008