Provider First Line Business Practice Location Address:
12230 ASHEVILLE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INMAN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29349-1845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-472-2144
Provider Business Practice Location Address Fax Number:
864-472-4696
Provider Enumeration Date:
05/31/2006