Provider First Line Business Practice Location Address:
2650 HIGHWAY 138 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JONESBORO
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30236-2744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-473-4436
Provider Business Practice Location Address Fax Number:
770-473-4698
Provider Enumeration Date:
08/29/2006