Provider First Line Business Practice Location Address:
1790 LAVISTA RD NE
Provider Second Line Business Practice Location Address:
EMMANUAL CENTER
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30329-3604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-467-8643
Provider Business Practice Location Address Fax Number:
404-812-3101
Provider Enumeration Date:
03/10/2011