Provider First Line Business Practice Location Address:
75 PIEDMONT AVE
Provider Second Line Business Practice Location Address:
STE 600 ATTN: MOREHOUSE MEDICAL ASSOCIATION
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30303-2544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-616-8201
Provider Business Practice Location Address Fax Number:
404-616-6201
Provider Enumeration Date:
07/21/2005