Provider First Line Business Practice Location Address:
7653 GARNERS FERRY ROAD
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:
29209-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-695-6150
Provider Business Practice Location Address Fax Number:
803-695-6146
Provider Enumeration Date:
03/28/2012