Provider First Line Business Practice Location Address:
S CAROLINA STATE UNIVERSITY
Provider Second Line Business Practice Location Address:
300 COLLEGE STREET, N.E.
Provider Business Practice Location Address City Name:
ORANGEBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29117-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-536-8625
Provider Business Practice Location Address Fax Number:
803-533-3801
Provider Enumeration Date:
03/26/2010