Provider First Line Business Practice Location Address:
3073 PANTHERSVILLE ROAD
Provider Second Line Business Practice Location Address:
MEDICAL CLINIC
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30034-3828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-212-4658
Provider Business Practice Location Address Fax Number:
404-244-5138
Provider Enumeration Date:
10/24/2007