Provider First Line Business Practice Location Address:
3 JOHNSTON STREET
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-352-1234
Provider Business Practice Location Address Fax Number:
912-352-0492
Provider Enumeration Date:
04/20/2010