Provider First Line Business Practice Location Address:
2400 MT. ZION PARKWAY
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE SOUTHWOOD MEDICAL CENTER
Provider Business Practice Location Address City Name:
JONESBORO
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-355-0743
Provider Business Practice Location Address Fax Number:
404-943-0641
Provider Enumeration Date:
08/10/2005