Provider First Line Business Practice Location Address:
74 CLAY ST SE
Provider Second Line Business Practice Location Address:
PSYCH OFFICE
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30317-2117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-730-8641
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/06/2007