Provider First Line Business Practice Location Address:
55 CARLTON STREET
Provider Second Line Business Practice Location Address:
UGA UNIVERSITY HEALTH CENTER
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30602-1755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-542-5617
Provider Business Practice Location Address Fax Number:
706-227-4763
Provider Enumeration Date:
08/15/2007