Provider First Line Business Practice Location Address:
453 LAKES BLVD SUITE B
Provider Second Line Business Practice Location Address:
LAKE PARK FAMILY CARE CLINIC
Provider Business Practice Location Address City Name:
LAKE PARK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-588-2866
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2007