Provider First Line Business Practice Location Address:
9320-C TWO NOTCH RD.
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:
29223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-462-1140
Provider Business Practice Location Address Fax Number:
803-462-1141
Provider Enumeration Date:
07/03/2006