Provider First Line Business Practice Location Address:
1434 BROADRICK DRIVE
Provider Second Line Business Practice Location Address:
NORTH GEORGIA UROLOGY CENTER
Provider Business Practice Location Address City Name:
DALTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-278-5961
Provider Business Practice Location Address Fax Number:
706-275-0280
Provider Enumeration Date:
07/21/2006