Provider First Line Business Practice Location Address:
4311 HARD SCRABBLE RD
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:
29229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-545-5700
Provider Business Practice Location Address Fax Number:
803-434-4699
Provider Enumeration Date:
03/20/2013