Provider First Line Business Practice Location Address:
4801 HARD SCRABBLE 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:
29229-9159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-699-2999
Provider Business Practice Location Address Fax Number:
803-699-2888
Provider Enumeration Date:
04/18/2007