Provider First Line Business Practice Location Address:
1135 CARTER ST
Provider Second Line Business Practice Location Address:
INDEPENDENCE HOUSE
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29204-2811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-786-1183
Provider Business Practice Location Address Fax Number:
803-735-1021
Provider Enumeration Date:
01/04/2007