Provider First Line Business Practice Location Address:
455 PHILIP BLVD STE 130
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE LAWRENCEVILLE MEDICAL OFFICE
Provider Business Practice Location Address City Name:
LAWRENCEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30046-8768
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-985-5000
Provider Business Practice Location Address Fax Number:
828-526-2914
Provider Enumeration Date:
08/14/2006