Provider First Line Business Practice Location Address:
54 LUMPKIN CAMPGROUND RD S
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
DAWSONVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30534-6196
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-781-9882
Provider Business Practice Location Address Fax Number:
770-205-5926
Provider Enumeration Date:
07/26/2006