Provider First Line Business Practice Location Address:
836 E 65TH STREET
Provider Second Line Business Practice Location Address:
42 MEDICAL ARTS
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-354-5780
Provider Business Practice Location Address Fax Number:
912-354-5782
Provider Enumeration Date:
08/20/2006