Provider First Line Business Practice Location Address:
1520 DEDRICK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MC INTYRE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31054-2736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-251-3012
Provider Business Practice Location Address Fax Number:
973-307-2048
Provider Enumeration Date:
07/29/2026