Provider First Line Business Practice Location Address:
723 BAXTER ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30605-1109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-355-3035
Provider Business Practice Location Address Fax Number:
706-355-3039
Provider Enumeration Date:
10/27/2006