Provider First Line Business Practice Location Address:
3073 PANTHERSVILLE RD
Provider Second Line Business Practice Location Address:
GEORGIA REGIONAL HOSPITAL
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30034-3828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-677-3782
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/18/2009