Provider First Line Business Practice Location Address:
698 S MILLEDGE AVE
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:
30605-1251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-543-2020
Provider Business Practice Location Address Fax Number:
706-549-6618
Provider Enumeration Date:
06/21/2005