Provider First Line Business Practice Location Address:
1365 CLIFTON ROAD NE
Provider Second Line Business Practice Location Address:
CLINIC A, 4TH FLOOR
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30322-4551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-778-3712
Provider Business Practice Location Address Fax Number:
404-778-5003
Provider Enumeration Date:
07/23/2008