Provider First Line Business Practice Location Address:
3 RICHLAND MEDICAL PARK
Provider Second Line Business Practice Location Address:
SUITE 240
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:
803-765-1550
Provider Business Practice Location Address Fax Number:
803-771-4379
Provider Enumeration Date:
02/09/2006