Provider First Line Business Practice Location Address:
132 MONTEITH 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:
29203-2714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-449-8450
Provider Business Practice Location Address Fax Number:
704-405-8549
Provider Enumeration Date:
03/31/2009