Provider First Line Business Practice Location Address:
4770 BUFORD HWY NE
Provider Second Line Business Practice Location Address:
MAIL STOP F-77, DIVISION OF NUTRITION
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-488-5609
Provider Business Practice Location Address Fax Number:
770-488-5369
Provider Enumeration Date:
04/10/2010