Provider First Line Business Practice Location Address:
1364 CLIFTON ROAD NE
Provider Second Line Business Practice Location Address:
DEPARTMENT OF PHARMACY
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30322-1059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-712-2356
Provider Business Practice Location Address Fax Number:
404-712-1991
Provider Enumeration Date:
06/30/2005