Provider First Line Business Practice Location Address:
9424 MARTINDALE RD
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:
29223-2048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-865-6342
Provider Business Practice Location Address Fax Number:
803-419-4169
Provider Enumeration Date:
05/16/2006