Provider First Line Business Practice Location Address:
2 MEDICAL PARK RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29203-6808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-545-5700
Provider Business Practice Location Address Fax Number:
803-434-4596
Provider Enumeration Date:
07/23/2014