Provider First Line Business Practice Location Address:
GEORGIA SOUTHERN UNIVERSITY HANNER FIELDHOUSE
Provider Second Line Business Practice Location Address:
HERTY DRIVE
Provider Business Practice Location Address City Name:
STATESBORO
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30460-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-486-7581
Provider Business Practice Location Address Fax Number:
912-486-7690
Provider Enumeration Date:
05/01/2007