Provider First Line Business Practice Location Address:
PROGRAM MAILSTOP E-05
Provider Second Line Business Practice Location Address:
CDC NAT'L IMMUNIZATION P
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-639-8723
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/09/2007