Provider First Line Business Practice Location Address:
770 PINE ST STE L15
Provider Second Line Business Practice Location Address:
ATTN: RADIOLOGY DEPARTMENT
Provider Business Practice Location Address City Name:
MACON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31201-7519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-746-1020
Provider Business Practice Location Address Fax Number:
478-746-0591
Provider Enumeration Date:
11/21/2005