Provider First Line Business Practice Location Address:
FAMILY LIFE CHAPLAIN
Provider Second Line Business Practice Location Address:
BUILDING 2606, DIXIE ROAD
Provider Business Practice Location Address City Name:
FORT BENNING
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-545-2017
Provider Business Practice Location Address Fax Number:
706-545-5254
Provider Enumeration Date:
09/05/2007