Provider First Line Business Practice Location Address:
845 CRABAPPLE DR
Provider Second Line Business Practice Location Address:
COMMUNITY MEDICAID COMP HOMES
Provider Business Practice Location Address City Name:
THOMASVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31757-1400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-227-2977
Provider Business Practice Location Address Fax Number:
229-227-2955
Provider Enumeration Date:
01/14/2009