Provider First Line Business Practice Location Address:
100 PRISON ROAD
Provider Second Line Business Practice Location Address:
FED CORR INST ESTILL
Provider Business Practice Location Address City Name:
ESTILL
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29918-0699
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-625-4607
Provider Business Practice Location Address Fax Number:
803-625-5636
Provider Enumeration Date:
08/29/2007