Registry details
Type
Individual
Primary specialty
—
Enumerated
Jul 1, 2009
License(s)
R8499 (IA), SP-207 (IA), 89014 (GA), TP619 (KY), 35.154412 (OH), 89014 (GA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1120 15TH ST | Augusta, GA 30912-1007 | 706-721-8623 |
| MAILING | 1120 15TH ST | Augusta, GA 30912-0004 | 706-721-8623 |
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