Provider First Line Business Practice Location Address:
1500 SHUTWELL STREET
Provider Second Line Business Practice Location Address:
BAINBRIDGE MEMORIAL HOSPITAL
Provider Business Practice Location Address City Name:
BAINBRIDGE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
39817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-243-6163
Provider Business Practice Location Address Fax Number:
229-243-3327
Provider Enumeration Date:
05/02/2007