MARY M DOMVILLE

CARROLLTON, GA
NPI1578573820
Former NameMARY MARY PENNINGTON
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363AM0700X Physician Assistant, Medical
(Licence: GA  003494)
Enumeration Date2006-08-09
Last Update Date2009-02-13
Business Address
Mrs. MARY M DOMVILLE P.A.
524 DIXIE ST
CARROLLTON, GA 30117-3805
Phone number: 770-832-2775
Mailing Address
Mrs. MARY M DOMVILLE P.A.
524 DIXIE ST
CARROLLTON, GA 30117-3805
Phone number: 770-832-2775
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