Provider First Line Business Practice Location Address:
URBAN LIFE BUILDING
Provider Second Line Business Practice Location Address:
140 DECATUR STREET
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30303-3030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-804-0878
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2021