Provider First Line Business Practice Location Address:
1745 PEACHTREE ROAD, SUITE U
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE BROOKWOOD MEDICAL CENTER
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:
404-888-7688
Provider Business Practice Location Address Fax Number:
404-355-1353
Provider Enumeration Date:
05/23/2005