Provider First Line Business Practice Location Address:
3408 COVINGTON HIGHWAY
Provider Second Line Business Practice Location Address:
GEORGIA DEPARTMENT OF JUVENILE JUSTICE
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-508-6509
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/18/2008