Provider First Line Business Practice Location Address:
1260 HIGHWAY 54 WEST, SUITE 101
Provider Second Line Business Practice Location Address:
FAYETTE CARE CLINIC
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-719-4620
Provider Business Practice Location Address Fax Number:
770-719-4622
Provider Enumeration Date:
08/09/2006