Provider First Line Business Practice Location Address:
20 GLENLAKE PARKWAY
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE GLENLAKE
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-686-7435
Provider Business Practice Location Address Fax Number:
404-686-4473
Provider Enumeration Date:
12/28/2005