Provider First Line Business Practice Location Address:
11 W. HOSPITAL ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANNING
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29102-2925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-433-4321
Provider Business Practice Location Address Fax Number:
803-433-0075
Provider Enumeration Date:
01/30/2012