Provider First Line Business Practice Location Address:
1190 MARTIN LUTHER KING JR BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31906-3527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-322-3218
Provider Business Practice Location Address Fax Number:
706-322-3219
Provider Enumeration Date:
10/11/2006