Provider First Line Business Practice Location Address:
HWY 27 SOUTH
Provider Second Line Business Practice Location Address:
P.O. BOX 98
Provider Business Practice Location Address City Name:
LUMPKIN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-838-4835
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/05/2017