Provider First Line Business Practice Location Address:
200 CRESCENT CENTRE PARK
Provider Second Line Business Practice Location Address:
INTERNAL MEDICINE HEALTH CARE TEAM A
Provider Business Practice Location Address City Name:
TUCKER
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-496-3625
Provider Business Practice Location Address Fax Number:
770-496-3717
Provider Enumeration Date:
08/30/2006