Provider First Line Business Practice Location Address:
115 BLARNEY DRIVE, SUITE 109
Provider Second Line Business Practice Location Address:
NORTHEAST MEDICAL CENTER
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-699-3233
Provider Business Practice Location Address Fax Number:
803-699-3919
Provider Enumeration Date:
05/26/2008