Provider First Line Business Practice Location Address:
HWY 36
Provider Second Line Business Practice Location Address:
GEORGIA DIAGNOSTIC CLASSIFICATION PRISON
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-504-2415
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/26/2015