Provider First Line Business Practice Location Address:
5340 GA HWY 20 SOUTH
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-788-9900
Provider Business Practice Location Address Fax Number:
770-788-1040
Provider Enumeration Date:
08/20/2006