Provider First Line Business Practice Location Address:
1300 UPPER LEMBREE RD.
Provider Second Line Business Practice Location Address:
BLD #100, SUITE A
Provider Business Practice Location Address City Name:
ROSWELL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-619-0004
Provider Business Practice Location Address Fax Number:
770-619-0252
Provider Enumeration Date:
11/17/2006