License Type Code = General
License Number = 1000735
Licensee Name = MID GA MEDICAL WIEGHT LOSS & WELLNESS CENTER
Business Name = MID GA MEDICAL WEIGHT LOSS & WELLLNESS CENTER
Business Address Line1 = 4061 VINEVILLE AVE
Business Address Line2 =
Business Address Line3 =
Business City = MACON
Business State = GA
Business Zip = 31210
Primary Phone = (478) 742-8760
Contact Name = LESLEY COWN
License Status = Active
Start Of Business Date = 2015-06-17
Out Of Business Date =
Contractor = No
Application Date = 2015-06-17
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