Provider First Line Business Practice Location Address:
644 N HIGHLAND AVE NE
Provider Second Line Business Practice Location Address:
SUITE 116
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30306-4533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-532-0011
Provider Business Practice Location Address Fax Number:
404-532-0010
Provider Enumeration Date:
08/30/2007