Provider First Line Business Practice Location Address:
1233 WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29201-3221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-233-0244
Provider Business Practice Location Address Fax Number:
803-339-1871
Provider Enumeration Date:
09/13/2005