Provider First Line Business Practice Location Address:
6439 GARNERS FERRY RD
Provider Second Line Business Practice Location Address:
RECOVERY EAST BLDING 106
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29209-1638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-776-4000
Provider Business Practice Location Address Fax Number:
803-695-6795
Provider Enumeration Date:
01/31/2015