Provider First Line Business Practice Location Address:
3579 HIGHWAY 138 SE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
STOCKBRIDGE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30281-4142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-507-0029
Provider Business Practice Location Address Fax Number:
770-507-9990
Provider Enumeration Date:
07/15/2006