Provider First Line Business Practice Location Address:
8 RICHLAND MEDICAL PARK DR STE 420
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:
29203-8004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-434-8050
Provider Business Practice Location Address Fax Number:
803-933-3005
Provider Enumeration Date:
09/19/2012