Provider First Line Business Practice Location Address:
1000 HALSEY AVE SE BLDG 550
Provider Second Line Business Practice Location Address:
NAS ATLANTA, NAVAL BRANCH HEALTH CLINIC-ATLANTA
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30060-4277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-655-5018
Provider Business Practice Location Address Fax Number:
678-655-5306
Provider Enumeration Date:
01/02/2007