Provider First Line Business Practice Location Address:
36671 HIGHWAY 23
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COBBTOWN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30420-6042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-684-2071
Provider Business Practice Location Address Fax Number:
912-684-2074
Provider Enumeration Date:
07/17/2006