Provider First Line Business Practice Location Address:
130 MEDICAL WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STOCKBRIDGE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30281-9088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-389-4543
Provider Business Practice Location Address Fax Number:
770-474-0566
Provider Enumeration Date:
02/22/2007