Provider First Line Business Practice Location Address:
8 RICHLAND MEDICAL PARK DR STE 420
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:
29203-8004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-545-6050
Provider Business Practice Location Address Fax Number:
803-545-6501
Provider Enumeration Date:
11/14/2006