Provider First Line Business Practice Location Address:
1190 FILBERT HWY
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29745-9324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-628-0004
Provider Business Practice Location Address Fax Number:
803-628-6004
Provider Enumeration Date:
08/31/2006