Provider First Line Business Practice Location Address:
150-160 NORTH LOUISVILLE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARLEM
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30814-5084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-449-8352
Provider Business Practice Location Address Fax Number:
706-449-8005
Provider Enumeration Date:
07/14/2013