Provider First Line Business Practice Location Address:
3 RICHLAND MEDICAL PARK DR STE 110
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:
29203-6850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-807-9388
Provider Business Practice Location Address Fax Number:
803-807-9391
Provider Enumeration Date:
07/18/2007