Provider First Line Business Practice Location Address:
1410 BLANDING ST STE 102
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:
29201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-256-2500
Provider Business Practice Location Address Fax Number:
803-777-2027
Provider Enumeration Date:
07/07/2006