Provider First Line Business Practice Location Address:
2689 HIGHWAY 155S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOCUST GROVE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-284-2070
Provider Business Practice Location Address Fax Number:
770-954-1849
Provider Enumeration Date:
07/31/2026