Provider First Line Business Practice Location Address:
145 PARK CENTRAL DR STE 100
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:
29203-6469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-408-3277
Provider Business Practice Location Address Fax Number:
803-408-3299
Provider Enumeration Date:
07/18/2005