Provider First Line Business Practice Location Address:
307 CLOVERDALE DR
Provider Second Line Business Practice Location Address:
INTENSIVE TREATMENT RESIDENCE PROGRAM
Provider Business Practice Location Address City Name:
THOMASVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31792-4018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-227-2977
Provider Business Practice Location Address Fax Number:
229-227-2955
Provider Enumeration Date:
09/05/2006