Provider First Line Business Practice Location Address:
2200 HARDEN 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:
29203-7107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-737-5339
Provider Business Practice Location Address Fax Number:
803-737-5436
Provider Enumeration Date:
01/24/2007