Provider First Line Business Practice Location Address:
1800 COLONIAL DR
Provider Second Line Business Practice Location Address:
COTTAGE C/ ADULT CLINICAIL SERVICES
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29203-6827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-898-0125
Provider Business Practice Location Address Fax Number:
803-898-0114
Provider Enumeration Date:
01/03/2013