Provider First Line Business Practice Location Address: 
1800 HOWELL MILL RD NW STE 275
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
ATLANTA
    Provider Business Practice Location Address State Name: 
GA
    Provider Business Practice Location Address Postal Code: 
30318-2538
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
404-756-1400
    Provider Business Practice Location Address Fax Number: 
404-756-1402
    Provider Enumeration Date: 
05/15/2006