Provider First Line Business Practice Location Address:
1002 HOSPITAL DR
Provider Second Line Business Practice Location Address:
BLDG-B
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:
678-565-7155
Provider Business Practice Location Address Fax Number:
678-565-7455
Provider Enumeration Date:
01/31/2007