Provider First Line Business Practice Location Address:
385 N CLARENDON AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SCOTTDALE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30079-1307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-377-5600
Provider Business Practice Location Address Fax Number:
404-292-0133
Provider Enumeration Date:
11/08/2006