Registry details
Type
Individual
Primary specialty
Physical Therapist
Enumerated
Mar 30, 2007
License(s)
PT004580 (GA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 901 18TH ST E | Tifton, GA 31794-3648 | 229-353-3347 |
| LOCATION | 901 18TH ST E | Tifton, GA 31794-3648 | 229-353-3347 |
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