Provider First Line Business Practice Location Address:
6100 GARNERS FERRY 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:
29209-1401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-783-4275
Provider Business Practice Location Address Fax Number:
803-783-0604
Provider Enumeration Date:
02/16/2007