Provider First Line Business Practice Location Address:
3000 ST MATTHEWS ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGEBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29118-1442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-395-2200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2005