Provider First Line Business Practice Location Address:
2445 BACK VALLEY RD
Provider Second Line Business Practice Location Address:
UPHILL SPRINGS PCH
Provider Business Practice Location Address City Name:
LYERLY
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-895-2144
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2008