Provider First Line Business Practice Location Address: 
101 E WOOD 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: 
29303-3040
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
864-560-6000
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
06/09/2020