Provider First Line Business Practice Location Address:
1380 CLEVELAND AVENUE
Provider Second Line Business Practice Location Address:
MAIN STREET CLINIC
Provider Business Practice Location Address City Name:
EAST POINT
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30344-6959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-765-0021
Provider Business Practice Location Address Fax Number:
404-765-0323
Provider Enumeration Date:
04/23/2007