Provider First Line Business Practice Location Address:
1478 DOGWOOD DRIVE, SE, SUITES B & C
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE CONYERS MEDICAL CENTER
Provider Business Practice Location Address City Name:
CONYERS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-413-4320
Provider Business Practice Location Address Fax Number:
706-865-6268
Provider Enumeration Date:
01/04/2006