Provider First Line Business Practice Location Address:
1968 PEACHTREE ROAD, NE
Provider Second Line Business Practice Location Address:
HOSPITAL SERVICES-THE SOUTHEAST PERMANENTE MEDICAL GROU
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:
404-364-7070
Provider Business Practice Location Address Fax Number:
404-778-5495
Provider Enumeration Date:
10/04/2006