Provider First Line Business Practice Location Address:
100 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOLKSTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31537-3018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-496-2522
Provider Business Practice Location Address Fax Number:
912-496-3329
Provider Enumeration Date:
12/05/2006