Provider First Line Business Practice Location Address:
489 N MILLEDGE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30601-3807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-613-6650
Provider Business Practice Location Address Fax Number:
706-613-6868
Provider Enumeration Date:
11/13/2006