Provider First Line Business Practice Location Address:
5 RICHLAND MEDICAL PARK DR
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:
29203-6863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-434-7812
Provider Business Practice Location Address Fax Number:
803-434-3737
Provider Enumeration Date:
10/08/2009