Provider First Line Business Practice Location Address:
2435 FOREST DRIVE
Provider Second Line Business Practice Location Address:
PROVIDENCE HOSPITAL
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-256-5600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2009