Provider First Line Business Practice Location Address:
1126 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30909-1810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-863-5082
Provider Business Practice Location Address Fax Number:
706-863-4082
Provider Enumeration Date:
11/23/2005