Provider First Line Business Practice Location Address:
6955 HWY 145 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARNESVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-384-5575
Provider Business Practice Location Address Fax Number:
706-384-4217
Provider Enumeration Date:
11/06/2006