Provider First Line Business Practice Location Address:
170 BASTILLE WAY, SUITE C
Provider Second Line Business Practice Location Address:
GINGER RIDGE BEHAVIORAL HEALTH SERVICES, LLC
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-461-7010
Provider Business Practice Location Address Fax Number:
770-461-7100
Provider Enumeration Date:
12/29/2011