Provider First Line Business Practice Location Address:
2 MEDICAL PARK RD STE 208
Provider Second Line Business Practice Location Address:
DEPT. OB/GYN
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29203-6839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-545-5746
Provider Business Practice Location Address Fax Number:
803-434-4596
Provider Enumeration Date:
08/02/2014