Provider First Line Business Practice Location Address:
146 N HOSPITAL DRIVE
Provider Second Line Business Practice Location Address:
SUITE 530
Provider Business Practice Location Address City Name:
WEST COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29169-4894
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-796-7270
Provider Business Practice Location Address Fax Number:
803-796-0106
Provider Enumeration Date:
08/10/2006