Provider First Line Business Practice Location Address:
93 HIGHWAY 19
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUMBER CITY
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31549-2556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-363-2484
Provider Business Practice Location Address Fax Number:
912-363-8182
Provider Enumeration Date:
04/28/2022