Provider First Line Business Practice Location Address:
100 PALMETTO HEALTH PKWY
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29212-1753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-907-7500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2016