Provider First Line Business Practice Location Address:
771 OLD NORCROSS RD STE 255
Provider Second Line Business Practice Location Address:
NORTHSIDE GWINNETT PRIMARY CARE
Provider Business Practice Location Address City Name:
LAWRENCEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-963-2967
Provider Business Practice Location Address Fax Number:
770-339-4585
Provider Enumeration Date:
06/16/2006