Provider First Line Business Practice Location Address:
3 RICHLAND MEDICAL PARK
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29203-6850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-744-7770
Provider Business Practice Location Address Fax Number:
803-744-7776
Provider Enumeration Date:
10/30/2006