Provider First Line Business Practice Location Address:
1695 S LUMPKIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30606-4742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-548-2239
Provider Business Practice Location Address Fax Number:
706-548-4428
Provider Enumeration Date:
06/11/2006