Provider First Line Business Practice Location Address:
1115 CALHOUN ST
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:
29201-2417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-254-6644
Provider Business Practice Location Address Fax Number:
803-254-2209
Provider Enumeration Date:
12/17/2009