Provider First Line Business Practice Location Address:
962 JOE FRANK HARRIS PKWY SE
Provider Second Line Business Practice Location Address:
SUITE 104; CARTERSVILLE MEDICAL ARTS CENTER
Provider Business Practice Location Address City Name:
CARTERSVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-386-0090
Provider Business Practice Location Address Fax Number:
770-387-9126
Provider Enumeration Date:
09/11/2006