Provider First Line Business Practice Location Address:
743 SPRING ST
Provider Second Line Business Practice Location Address:
NORTHEAST GEORGIA MEDICAL CENTER
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30501-3899
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-535-3553
Provider Business Practice Location Address Fax Number:
770-531-6268
Provider Enumeration Date:
08/04/2008