Provider First Line Business Practice Location Address:
1016 HOSPITAL DR BLDG B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STOCKBRIDGE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30281-7384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-289-0188
Provider Business Practice Location Address Fax Number:
678-289-0187
Provider Enumeration Date:
10/01/2006