Provider First Line Business Practice Location Address:
1745 PEACHTREE STREET
Provider Second Line Business Practice Location Address:
SUITE U, KAISER PERMANENTE BROOKWOOD MEDICAL OFFICE
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-888-7646
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/19/2006