Provider First Line Business Practice Location Address:
305 CARROLLTON HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-562-0777
Provider Business Practice Location Address Fax Number:
770-562-0333
Provider Enumeration Date:
03/07/2013