Provider First Line Business Practice Location Address:
341 PONCE DE LEON AVE
Provider Second Line Business Practice Location Address:
THE PONCE DE LEON CENTER
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-616-2440
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2006