Provider First Line Business Practice Location Address:
900 TOWNE LAKE PKWY STE 410
Provider Second Line Business Practice Location Address:
TOWNE LAKE PRIMARY CARE
Provider Business Practice Location Address City Name:
WOODSTOCK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30189-1604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-445-0819
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2006