Provider First Line Business Practice Location Address:
CLARK-HOLDER CLINIC, P.A.
Provider Second Line Business Practice Location Address:
303 SMITH STREET
Provider Business Practice Location Address City Name:
LAGRANGE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-882-8831
Provider Business Practice Location Address Fax Number:
706-812-4091
Provider Enumeration Date:
06/29/2006