Provider First Line Business Practice Location Address:
8 RICHLAND MEDICAL PARK ROAD
Provider Second Line Business Practice Location Address:
SUITE 420
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29203-8004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-545-6500
Provider Business Practice Location Address Fax Number:
803-545-6051
Provider Enumeration Date:
04/23/2008