Provider First Line Business Practice Location Address:
620 BROAD ST
Provider Second Line Business Practice Location Address:
CENTRAL STATE HOSPITAL
Provider Business Practice Location Address City Name:
MILLEDGEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31062-7525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-445-4128
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2009