Provider First Line Business Practice Location Address:
MUSC & SCDC MEDICAL ANNEX @ KIRKLAND CORRECTIONAL FACIL
Provider Second Line Business Practice Location Address:
4344 BROAD RIVER ROAD
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-675-6290
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/04/2009