Provider First Line Business Practice Location Address:
3 SOUTH PACIFIC AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29745-1607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-684-1361
Provider Business Practice Location Address Fax Number:
803-684-1855
Provider Enumeration Date:
02/21/2007