Provider First Line Business Practice Location Address:
6108 GARNERS FERRY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29209-1401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-647-1265
Provider Business Practice Location Address Fax Number:
803-647-1266
Provider Enumeration Date:
01/23/2006