Provider First Line Business Practice Location Address:
1260 S MILLEDGE AVE
Provider Second Line Business Practice Location Address:
SUITE F-1
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-543-7386
Provider Business Practice Location Address Fax Number:
706-543-8544
Provider Enumeration Date:
03/14/2007