Provider First Line Business Practice Location Address:
10204 TWO NOTCH RD
Provider Second Line Business Practice Location Address:
TARGET PHARMACY 1319
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29229-4386
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-788-0951
Provider Business Practice Location Address Fax Number:
803-788-0951
Provider Enumeration Date:
06/27/2011