Provider First Line Business Practice Location Address:
9 RICHLAND MEDICAL PARK DR
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29203-6859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-296-7304
Provider Business Practice Location Address Fax Number:
803-296-7329
Provider Enumeration Date:
06/30/2006