Provider First Line Business Practice Location Address:
TED SMITH FAMILY FOOTBALL CENTER
Provider Second Line Business Practice Location Address:
205 LANIER DRIVE
Provider Business Practice Location Address City Name:
STATESBORO
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30458-1524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-478-5509
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/12/2026