Provider First Line Business Practice Location Address:
EC3326 LANEY WALKER BLVD
Provider Second Line Business Practice Location Address:
MEDICAL COLLEGE OF GEORGIA
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-721-4425
Provider Business Practice Location Address Fax Number:
706-721-3990
Provider Enumeration Date:
12/24/2009