Provider First Line Business Practice Location Address:
836 EAST 65TH STREET, 4 MEDICAL ARTS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31405-4491
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-351-0057
Provider Business Practice Location Address Fax Number:
912-351-0074
Provider Enumeration Date:
12/20/2006