Provider First Line Business Practice Location Address:
2402 NORTH TIFT AVE.
Provider Second Line Business Practice Location Address:
STE. 102 SOUTH GEORGIA PSYCHIATRIC AND COUNSELING CENTE
Provider Business Practice Location Address City Name:
TIFTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31794
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-387-8878
Provider Business Practice Location Address Fax Number:
229-387-8881
Provider Enumeration Date:
07/12/2006