Provider First Line Business Practice Location Address:
130 OAKSIDE COURT
Provider Second Line Business Practice Location Address:
STE A MARIETTA DERMATOLOGY ASSOCIATES PA
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-422-1013
Provider Business Practice Location Address Fax Number:
770-514-5996
Provider Enumeration Date:
05/01/2007