Provider First Line Business Practice Location Address:
1 RICHLAND MEDICAL PARK DR STE 300
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:
29203-6831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-545-5350
Provider Business Practice Location Address Fax Number:
803-545-5353
Provider Enumeration Date:
03/01/2006