Provider First Line Business Practice Location Address:
2692 HARRIS ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
EAST POINT
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30344-2672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-228-4548
Provider Business Practice Location Address Fax Number:
404-228-4597
Provider Enumeration Date:
08/05/2010