Provider First Line Business Practice Location Address:
2801 DEKALB MEDICAL PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITHONIA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30058-4996
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-372-3943
Provider Business Practice Location Address Fax Number:
904-212-1618
Provider Enumeration Date:
08/18/2026