Provider First Line Business Practice Location Address:
229 N PARSON ST
Provider Second Line Business Practice Location Address:
SUITE 218
Provider Business Practice Location Address City Name:
WEST COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29169-6451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-939-7275
Provider Business Practice Location Address Fax Number:
803-939-7255
Provider Enumeration Date:
10/24/2006