Provider First Line Business Practice Location Address:
80 JESSE HILL DRIVE
Provider Second Line Business Practice Location Address:
GRADY MEMORIAL HOSPITAL
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-427-3397
Provider Business Practice Location Address Fax Number:
205-427-3397
Provider Enumeration Date:
03/22/2016