Provider First Line Business Practice Location Address:
3579 HIGHWAY 138
Provider Second Line Business Practice Location Address:
SUITE 202
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:
770-474-6111
Provider Business Practice Location Address Fax Number:
770-474-5897
Provider Enumeration Date:
07/02/2006