Provider First Line Business Practice Location Address:
6000 JOE FRANK HARRIS PKWY NW
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
ADAIRSVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30103-2443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-773-3521
Provider Business Practice Location Address Fax Number:
770-773-9882
Provider Enumeration Date:
12/28/2006