Provider First Line Business Practice Location Address: 
GRADY MEMORIAL HOSPITAL
    Provider Second Line Business Practice Location Address: 
80 JESSE HILL JR. DR.
    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: 
404-616-7436
    Provider Business Practice Location Address Fax Number: 
404-616-9084
    Provider Enumeration Date: 
03/29/2007