Provider First Line Business Practice Location Address:
2 MEDICAL PARK
Provider Second Line Business Practice Location Address:
STE. 306 SURGERY -
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-256-2657
Provider Business Practice Location Address Fax Number:
803-933-9545
Provider Enumeration Date:
07/19/2011