Provider First Line Business Practice Location Address: 
1000 JOHNSON FERRY ROAD, NE
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
ATLANTA
    Provider Business Practice Location Address State Name: 
GA
    Provider Business Practice Location Address Postal Code: 
30342
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
404-303-0476
    Provider Business Practice Location Address Fax Number: 
404-851-6813
    Provider Enumeration Date: 
08/03/2006