Provider First Line Business Practice Location Address:
1530 DEKALB AVE NE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30307-2176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-444-7160
Provider Business Practice Location Address Fax Number:
404-996-2605
Provider Enumeration Date:
07/22/2006