Provider First Line Business Practice Location Address:
2 MEDICAL PARK ROAD
Provider Second Line Business Practice Location Address:
SUITE 506
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29203-6830
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:
07/18/2006