Provider First Line Business Practice Location Address:
240 CANDLER RD SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30317-3436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-371-8221
Provider Business Practice Location Address Fax Number:
404-243-6386
Provider Enumeration Date:
06/25/2007