Provider First Line Business Practice Location Address:
532 MARTIN LUTHER KING JR. DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUMPKIN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-838-9911
Provider Business Practice Location Address Fax Number:
229-838-9856
Provider Enumeration Date:
10/20/2006