Provider First Line Business Practice Location Address:
1365A CLIFTON RD NE
Provider Second Line Business Practice Location Address:
DEPARTMENT OF OTOLARYNGOLOGY
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30322-1013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-778-3381
Provider Business Practice Location Address Fax Number:
404-778-4295
Provider Enumeration Date:
09/11/2008