Provider First Line Business Practice Location Address:
109 HOSPITAL DR W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29169-3405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-939-2788
Provider Business Practice Location Address Fax Number:
803-939-4640
Provider Enumeration Date:
03/31/2006