Provider First Line Business Practice Location Address: 
5126 HOSPITAL DR NE
    Provider Second Line Business Practice Location Address: 
DEPARTMENT OF RADIOLOGY
    Provider Business Practice Location Address City Name: 
COVINGTON
    Provider Business Practice Location Address State Name: 
GA
    Provider Business Practice Location Address Postal Code: 
30014-2566
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
770-385-4588
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
08/02/2011