Provider First Line Business Practice Location Address:
747 SOUTH 8TH STREET
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
GRIFFIN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30224-4880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-228-1767
Provider Business Practice Location Address Fax Number:
770-228-7562
Provider Enumeration Date:
08/31/2006