Provider First Line Business Practice Location Address: 
2000 HAMPTON STREET
    Provider Second Line Business Practice Location Address: 
RICHLAND COUNTY HEALTH DEPT.
    Provider Business Practice Location Address City Name: 
COLUMBIA
    Provider Business Practice Location Address State Name: 
SC
    Provider Business Practice Location Address Postal Code: 
29204
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
803-576-2926
    Provider Business Practice Location Address Fax Number: 
803-576-2880
    Provider Enumeration Date: 
11/03/2014