Provider First Line Business Practice Location Address:
1615 STATE HIGHWAY 17
Provider Second Line Business Practice Location Address:
STE 9
Provider Business Practice Location Address City Name:
YOUNG HARRIS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30582-1882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-238-7217
Provider Business Practice Location Address Fax Number:
423-954-7408
Provider Enumeration Date:
09/05/2013