Provider First Line Business Practice Location Address:
7535 GARNERS FERRY RD
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-776-6605
Provider Business Practice Location Address Fax Number:
803-783-3324
Provider Enumeration Date:
09/13/2012