Provider First Line Business Practice Location Address:
9 RICHLAND MEDICAL PARK DR STE 500
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:
29203-6870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-434-2833
Provider Business Practice Location Address Fax Number:
803-434-2834
Provider Enumeration Date:
06/30/2006