Provider First Line Business Practice Location Address:
9 RICHLAND MEDICAL PARK DR
Provider Second Line Business Practice Location Address:
SUITE 440
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29203-6859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-434-2767
Provider Business Practice Location Address Fax Number:
803-434-2850
Provider Enumeration Date:
12/15/2006