Provider First Line Business Practice Location Address:
3 RICHLAND MEDICAL PARK
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:
29203-1466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-753-7524
Provider Business Practice Location Address Fax Number:
803-753-8389
Provider Enumeration Date:
07/20/2006