Provider First Line Business Practice Location Address:
WJB DORN VAMC
Provider Second Line Business Practice Location Address:
6439 GARNERS FERRY ROAD
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29209-1639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-695-6811
Provider Business Practice Location Address Fax Number:
803-695-6745
Provider Enumeration Date:
07/10/2006