Provider First Line Business Practice Location Address:
750 TOWN PARK LANE
Provider Second Line Business Practice Location Address:
INTERNAL MEDICINE HEALTH CARE TEAM A
Provider Business Practice Location Address City Name:
KENNESAW
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-514-5403
Provider Business Practice Location Address Fax Number:
770-514-5493
Provider Enumeration Date:
09/01/2006