Provider First Line Business Practice Location Address:
1850 LAUREL ST
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:
29201-2627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-256-3400
Provider Business Practice Location Address Fax Number:
803-806-3549
Provider Enumeration Date:
09/27/2008