Provider First Line Business Practice Location Address:
125 DECATUR ST
Provider Second Line Business Practice Location Address:
INTERCOLLEGIATE ATHLETICS
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-413-4039
Provider Business Practice Location Address Fax Number:
404-413-4039
Provider Enumeration Date:
07/12/2006