Provider First Line Business Practice Location Address:
1410 COLONAL LIFE BLVD
Provider Second Line Business Practice Location Address:
#160 A BRIGHTER SMILE GENERAL AND COSMETIC DENTISTRY
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-239-2200
Provider Business Practice Location Address Fax Number:
803-239-2201
Provider Enumeration Date:
12/12/2006