Provider First Line Business Practice Location Address:
5 LAKE CAROLINA WAY STE 210
Provider Second Line Business Practice Location Address:
PARKSIDE DENTISTRY, LLC
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29229-7563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-736-8606
Provider Business Practice Location Address Fax Number:
803-736-8696
Provider Enumeration Date:
12/24/2007