Provider First Line Business Practice Location Address:
BALDWIN STATE PRISON
Provider Second Line Business Practice Location Address:
128 LAYING FARM RD
Provider Business Practice Location Address City Name:
HARDWICK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-445-4984
Provider Business Practice Location Address Fax Number:
478-445-2660
Provider Enumeration Date:
05/23/2007