Provider First Line Business Practice Location Address:
300 PALMETTO HEALTH PKWY STE 201
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:
29212-1762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-434-6812
Provider Business Practice Location Address Fax Number:
803-434-7306
Provider Enumeration Date:
04/14/2006