Provider First Line Business Practice Location Address:
1409 DEVINE STREET
Provider Second Line Business Practice Location Address:
UNIVERSITY OF SC THOMASON STUDENT HEALTH CENTER
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-777-3658
Provider Business Practice Location Address Fax Number:
803-777-0126
Provider Enumeration Date:
04/06/2007