Provider First Line Business Practice Location Address:
2124 CANDLER ROAD
Provider Second Line Business Practice Location Address:
JENCARE NEIGHBORHOOD MEDICAL CENTER SOUTH DEKALB, LLC
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30032-5500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-836-0272
Provider Business Practice Location Address Fax Number:
404-420-2445
Provider Enumeration Date:
07/23/2012