Provider First Line Business Practice Location Address:
3700 ATLANTA HIGHWAY 141 GEORGIA SQUARE MALL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30606-7420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-613-6409
Provider Business Practice Location Address Fax Number:
706-613-5514
Provider Enumeration Date:
01/11/2010