Provider First Line Business Practice Location Address:
9 RICHLAND MEDICAL PARK DR
Provider Second Line Business Practice Location Address:
STE 510
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:
803-256-2483
Provider Business Practice Location Address Fax Number:
803-799-4624
Provider Enumeration Date:
06/09/2006