Provider First Line Business Practice Location Address:
3555 HARDEN STREET EXT STE 301
Provider Second Line Business Practice Location Address:
UNIVERSITY OF SOUTH CAROLINA SCHOOL OF MEDICINE
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29203-6894
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-434-4236
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2006