Provider First Line Business Practice Location Address: 
UNIVERSITY OF SOUTH CAROLINA
    Provider Second Line Business Practice Location Address: 
THOMSON STUDENT HEALTH CENTER WCC
    Provider Business Practice Location Address City Name: 
COLUMBIA
    Provider Business Practice Location Address State Name: 
SC
    Provider Business Practice Location Address Postal Code: 
29208-0001
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
803-777-6816
    Provider Business Practice Location Address Fax Number: 
803-777-9063
    Provider Enumeration Date: 
01/12/2006