Provider First Line Business Practice Location Address:
6000 GARNERS FERRY RD
Provider Second Line Business Practice Location Address:
BOX
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29209-1303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-479-7010
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2007