Provider First Line Business Practice Location Address:
396 LIBERTY STREET
Provider Second Line Business Practice Location Address:
THOMASVILLE DENTAL CENTER
Provider Business Practice Location Address City Name:
THOMASVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-227-9070
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2006