Provider First Line Business Practice Location Address:
1486 E MAIN ST
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:
29307-2204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-585-2501
Provider Business Practice Location Address Fax Number:
864-585-2714
Provider Enumeration Date:
09/27/2005