Provider First Line Business Practice Location Address: 
1364 CLIFTON RD NE
    Provider Second Line Business Practice Location Address: 
EMORY UNIV SCH OF MED, DEPT. OF ANESTHESIOLOGY, B-355
    Provider Business Practice Location Address City Name: 
ATLANTA
    Provider Business Practice Location Address State Name: 
GA
    Provider Business Practice Location Address Postal Code: 
30322-1059
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
404-778-0695
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
05/19/2009