Provider First Line Business Practice Location Address:
1224 SUMTER ST
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29201-3357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-777-2622
Provider Business Practice Location Address Fax Number:
803-253-4143
Provider Enumeration Date:
07/20/2006