Provider First Line Business Practice Location Address:
35 LUMPKIN CAMPGROUND RD N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAWSONVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30534-6206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-216-6446
Provider Business Practice Location Address Fax Number:
706-216-6457
Provider Enumeration Date:
12/07/2005