Provider First Line Business Practice Location Address:
1600 TAYLOR STREET
Provider Second Line Business Practice Location Address:
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:
803-779-7783
Provider Business Practice Location Address Fax Number:
803-217-3571
Provider Enumeration Date:
06/20/2006