Provider First Line Business Practice Location Address:
146 E HOSPITAL DR STE 120B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29169-4800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-739-3570
Provider Business Practice Location Address Fax Number:
803-739-3575
Provider Enumeration Date:
05/22/2006