Provider First Line Business Practice Location Address:
23 MEDICAL GROUP
Provider Second Line Business Practice Location Address:
3278 MITCHELL BLVD
Provider Business Practice Location Address City Name:
MOODY A F B
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31699-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-257-1459
Provider Business Practice Location Address Fax Number:
229-257-5520
Provider Enumeration Date:
12/14/2009