Provider First Line Business Practice Location Address:
1700 MEDICAL WAY
Provider Second Line Business Practice Location Address:
EASTSIDE MEDICAL CENTER
Provider Business Practice Location Address City Name:
SNELLVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-736-2376
Provider Business Practice Location Address Fax Number:
770-736-2379
Provider Enumeration Date:
05/03/2006