Provider First Line Business Practice Location Address:
8 MEDICAL PARK DR
Provider Second Line Business Practice Location Address:
SUITE 410
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29203-8005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-540-1000
Provider Business Practice Location Address Fax Number:
803-540-1050
Provider Enumeration Date:
03/08/2006