Provider First Line Business Practice Location Address:
1300 CONSTITUTION RD SE
Provider Second Line Business Practice Location Address:
METRO STATE PRISON
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30316-4604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-624-2292
Provider Business Practice Location Address Fax Number:
404-624-2268
Provider Enumeration Date:
05/22/2007