Provider First Line Business Practice Location Address:
1308 LAUREL STREET
Provider Second Line Business Practice Location Address:
PALMETTO SENIOR CARE LAUREL
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:
803-931-8166
Provider Business Practice Location Address Fax Number:
803-931-8183
Provider Enumeration Date:
07/31/2006