Provider First Line Business Practice Location Address:
1450 BARNETT SHOALS RD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30605-2748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-543-6443
Provider Business Practice Location Address Fax Number:
706-543-8202
Provider Enumeration Date:
12/28/2006