Provider First Line Business Practice Location Address:
3 RICHLAND MEDICAL PARK DR STE 330
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-434-7100
Provider Business Practice Location Address Fax Number:
803-434-6889
Provider Enumeration Date:
06/28/2010