Provider First Line Business Practice Location Address:
GEORGIA SOUTHERN UNIVERSITY
Provider Second Line Business Practice Location Address:
HEALTH & KINESIOLOGY
Provider Business Practice Location Address City Name:
STATESBORO
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30460-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-681-5268
Provider Business Practice Location Address Fax Number:
912-681-0381
Provider Enumeration Date:
07/17/2007