Provider First Line Business Practice Location Address:
1023A W DEKALB ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMDEN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29020-4162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-424-0064
Provider Business Practice Location Address Fax Number:
803-424-0065
Provider Enumeration Date:
12/05/2006