Provider First Line Business Practice Location Address:
1000 CHASTAIN ROAD MD 5200 HOUSE 52
Provider Second Line Business Practice Location Address:
KENNESAW STATE UNIVERSITY HEALTH CLINIC
Provider Business Practice Location Address City Name:
KENNESAW
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30144-5591
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-423-6644
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/04/2006