Provider First Line Business Practice Location Address:
9 RICHLAND MEDICAL PARK
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29203-6859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-254-0670
Provider Business Practice Location Address Fax Number:
803-254-4595
Provider Enumeration Date:
04/25/2006