Provider First Line Business Practice Location Address:
3 RICHLAND MEDICAL PARK DR STE 120
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:
803-434-8866
Provider Business Practice Location Address Fax Number:
803-933-3049
Provider Enumeration Date:
01/11/2006