Provider First Line Business Practice Location Address:
140 APPLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARNWELL
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29812-3022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-541-9124
Provider Business Practice Location Address Fax Number:
803-584-7003
Provider Enumeration Date:
04/20/2007