Provider First Line Business Practice Location Address:
1365A CLIFTON ROAD NE
Provider Second Line Business Practice Location Address:
DEPARTMENT OF OTOLARYNGOLOGY
Provider Business Practice Location Address City Name:
ATLANAT
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-778-5712
Provider Business Practice Location Address Fax Number:
404-778-4295
Provider Enumeration Date:
09/20/2006