Provider First Line Business Practice Location Address:
79 HOLDER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUMPKIN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-838-1252
Provider Business Practice Location Address Fax Number:
229-838-1242
Provider Enumeration Date:
06/10/2005