Provider First Line Business Practice Location Address:
2400 MOUNT ZION PKWY
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE SOUTHWOOD COMPREHENSIVE MEDICAL CENTE
Provider Business Practice Location Address City Name:
JONESBORO
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30236-2500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-603-3649
Provider Business Practice Location Address Fax Number:
404-638-5293
Provider Enumeration Date:
10/19/2009