Provider First Line Business Practice Location Address:
CHRISTIAN COUNSELOR MA LOU GHOLSON
Provider Second Line Business Practice Location Address:
549 LAMAR DRIVE
Provider Business Practice Location Address City Name:
FOREST PARK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30294
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-254-4643
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/04/2019