Provider First Line Business Practice Location Address:
1255 GA-54
Provider Second Line Business Practice Location Address:
EMERGENCY DEPARTMENT
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-491-7152
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/02/2009