Provider First Line Business Practice Location Address:
550 PEACHTREE ST NE
Provider Second Line Business Practice Location Address:
CRAWFORD LONG HOSPITAL, DAVIS FISCHER BLDG
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30308-2247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-686-1913
Provider Business Practice Location Address Fax Number:
404-712-4780
Provider Enumeration Date:
09/22/2006