Provider First Line Business Practice Location Address:
1350 WALTON WAY
Provider Second Line Business Practice Location Address:
UNIVERSITY HOSPITAL
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30901-2612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-774-8948
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2006