Provider First Line Business Practice Location Address:
1001 JOHNSON FERRY ROAD
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE PEDIATRIC SERVICES
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-257-3219
Provider Business Practice Location Address Fax Number:
404-250-2850
Provider Enumeration Date:
04/25/2006