Provider First Line Business Practice Location Address:
2601 READ ST
Provider Second Line Business Practice Location Address:
SUITE I-2
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29204-7861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-834-7100
Provider Business Practice Location Address Fax Number:
802-834-7102
Provider Enumeration Date:
03/23/2009