Provider First Line Business Practice Location Address:
585 COBB AVE NW
Provider Second Line Business Practice Location Address:
KENNESAW HALL BUILDING 1; ROOM 2401; MD 0117
Provider Business Practice Location Address City Name:
KENNESAW
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30144-5563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
470-578-6600
Provider Business Practice Location Address Fax Number:
470-578-9102
Provider Enumeration Date:
01/16/2008