Provider First Line Business Practice Location Address:
212 EDGEWOOD AVE 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:
30303-3027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-688-2211
Provider Business Practice Location Address Fax Number:
404-688-2226
Provider Enumeration Date:
12/20/2019