Provider First Line Business Practice Location Address:
242 KING AVE
Provider Second Line Business Practice Location Address:
MEDICAL SERVICES BUILDING, FIRST FLOOR
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-475-3511
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/04/2012