Provider First Line Business Practice Location Address:
CENTRAL ELEMENTARY SCHOOL
Provider Second Line Business Practice Location Address:
14159 HWY 26 WEST
Provider Business Practice Location Address City Name:
LUCEDALE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-947-2429
Provider Business Practice Location Address Fax Number:
601-947-1421
Provider Enumeration Date:
05/03/2007