Provider First Line Business Practice Location Address:
5440 HILLANDALE DRIVE
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE PANOLA MEDICAL CENTER
Provider Business Practice Location Address City Name:
LITHONIA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-322-3216
Provider Business Practice Location Address Fax Number:
770-938-1759
Provider Enumeration Date:
02/23/2007