Provider First Line Business Practice Location Address:
1199 PRINCE AVENUE
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30606-1426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-475-1920
Provider Business Practice Location Address Fax Number:
706-475-1921
Provider Enumeration Date:
10/12/2012