Provider First Line Business Practice Location Address:
148 CLINIC AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARROLLTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-838-8640
Provider Business Practice Location Address Fax Number:
770-838-8650
Provider Enumeration Date:
05/31/2006