Provider First Line Business Practice Location Address:
201 COLUMBIA MALL BLVD
Provider Second Line Business Practice Location Address:
STE 141
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29223-7536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-320-4521
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/29/2008