Provider First Line Business Practice Location Address:
100 PALMETTO HEALTH PKWY STE 220
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:
29212-1755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-749-0693
Provider Business Practice Location Address Fax Number:
414-527-8046
Provider Enumeration Date:
05/15/2006