Provider First Line Business Practice Location Address:
265 BOULEVARD
Provider Second Line Business Practice Location Address:
4TH FLOOR THE CENTER FOR HEALTH AND REHABILITATION
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-612-1649
Provider Business Practice Location Address Fax Number:
404-893-6293
Provider Enumeration Date:
11/30/2006