Provider First Line Business Practice Location Address:
2 MEDICAL PARK ROAD SUITE 501
Provider Second Line Business Practice Location Address:
USC-DEPT. OF INTERNAL MEDICINE
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29203-6876
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-540-1000
Provider Business Practice Location Address Fax Number:
803-540-1075
Provider Enumeration Date:
10/05/2006