Provider First Line Business Practice Location Address: 
393 E WALNUT STREET KAISER PERMANENTE
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
PASADENA
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
91188-0001
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
800-541-7946
    Provider Business Practice Location Address Fax Number: 
626-405-2675
    Provider Enumeration Date: 
01/04/2008