Provider First Line Business Practice Location Address:
101 BANKS STATION
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE FAYETTEVILLE MEDICAL CENTER
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-364-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2006