Provider First Line Business Practice Location Address:
BOLL MALL PARKWAY
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE STONECREST 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:
30038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-323-7510
Provider Business Practice Location Address Fax Number:
678-323-7510
Provider Enumeration Date:
10/12/2006