Provider First Line Business Practice Location Address:
95 COLLIER RD
Provider Second Line Business Practice Location Address:
SUITE 4045 PEACHTREE NEUROLOGICAL CLINIC
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-351-2270
Provider Business Practice Location Address Fax Number:
404-352-1969
Provider Enumeration Date:
10/31/2005