Provider First Line Business Practice Location Address:
2000 SOUTH PARK PLACE
Provider Second Line Business Practice Location Address:
WELL STAR
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30339-2013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-956-6477
Provider Business Practice Location Address Fax Number:
177-095-6463
Provider Enumeration Date:
10/24/2007