Provider First Line Business Practice Location Address:
300 PALMETTO HEALTH PKWY STE 401
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:
29212-1764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-296-3273
Provider Business Practice Location Address Fax Number:
803-296-7061
Provider Enumeration Date:
01/03/2006