Provider First Line Business Practice Location Address:
16TH STREET BUILDING 13514
Provider Second Line Business Practice Location Address:
YOUTH CHALLANGE ACADEMY
Provider Business Practice Location Address City Name:
FT STEWART
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-242-6542
Provider Business Practice Location Address Fax Number:
912-767-6445
Provider Enumeration Date:
08/31/2006