Provider First Line Business Practice Location Address:
3506 MEDICAL DR STE A
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:
29203-6516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-256-2333
Provider Business Practice Location Address Fax Number:
803-256-1580
Provider Enumeration Date:
05/08/2007