Provider First Line Business Practice Location Address:
119 AMBULANCE DR
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
CARROLLTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30117-3857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-834-0606
Provider Business Practice Location Address Fax Number:
770-834-1833
Provider Enumeration Date:
12/11/2008