Provider First Line Business Practice Location Address:
1500 E. SHOTWELL ST.
Provider Second Line Business Practice Location Address:
MEMORIAL HOSPITAL & MANOR
Provider Business Practice Location Address City Name:
BAINBRIDGE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
39819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-243-6200
Provider Business Practice Location Address Fax Number:
229-243-3317
Provider Enumeration Date:
05/22/2006