Provider First Line Business Practice Location Address:
15 MEDICAL PARK DR
Provider Second Line Business Practice Location Address:
SUITE 141
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-434-4300
Provider Business Practice Location Address Fax Number:
803-434-4351
Provider Enumeration Date:
03/06/2007