Provider First Line Business Practice Location Address:
7 MEDICAL PARK RD
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29203-6873
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-434-3533
Provider Business Practice Location Address Fax Number:
803-434-3094
Provider Enumeration Date:
03/03/2006