Provider First Line Business Practice Location Address:
125 POWELL MILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTANBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29301-1531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-576-7255
Provider Business Practice Location Address Fax Number:
864-967-7020
Provider Enumeration Date:
01/29/2008