Provider First Line Business Practice Location Address:
1444 BARNWELL ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-256-6274
Provider Business Practice Location Address Fax Number:
803-256-6275
Provider Enumeration Date:
10/04/2006