Provider First Line Business Practice Location Address:
STE 430
Provider Second Line Business Practice Location Address:
9 RICHLAND MEDICAL PK
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29203-6870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-765-9435
Provider Business Practice Location Address Fax Number:
803-765-2446
Provider Enumeration Date:
05/20/2006