Provider First Line Business Practice Location Address: 
550 PEACHTREE ST NE
    Provider Second Line Business Practice Location Address: 
EMORY CRAWFORD LONG HOSPITAL - HOSPITAL MEDICINE DEPT
    Provider Business Practice Location Address City Name: 
ATLANTA
    Provider Business Practice Location Address State Name: 
GA
    Provider Business Practice Location Address Postal Code: 
30308-2247
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
404-686-7869
    Provider Business Practice Location Address Fax Number: 
404-778-5495
    Provider Enumeration Date: 
07/24/2006