Provider First Line Business Practice Location Address:
1125 CAPITOL AVE SW
Provider Second Line Business Practice Location Address:
SOUTH FULTON HEALTH CTR
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-730-5406
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2006