Provider First Line Business Practice Location Address:
3 MEDICAL PARK RD
Provider Second Line Business Practice Location Address:
110
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29203-6873
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-434-4603
Provider Business Practice Location Address Fax Number:
803-434-3866
Provider Enumeration Date:
01/20/2006