Provider First Line Business Practice Location Address:
1100 BROOKSTONE PARKWAY, STE 101
Provider Second Line Business Practice Location Address:
NORTH COLUMBUS MEDICAL HOME
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-626-3810
Provider Business Practice Location Address Fax Number:
706-626-3846
Provider Enumeration Date:
06/11/2008