Provider First Line Business Practice Location Address:
1650 HARDEMAN AVE
Provider Second Line Business Practice Location Address:
ATTN: RADIOLOGY DEPARTMENT
Provider Business Practice Location Address City Name:
MACON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31201-1418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-633-4738
Provider Business Practice Location Address Fax Number:
478-749-9736
Provider Enumeration Date:
10/27/2005