Provider First Line Business Practice Location Address:
4000 DEKALB TECHNOLOGY PKWY
Provider Second Line Business Practice Location Address:
STE. 400 KAISER PERMANENTE-DEKALB TECHNOLOGY CENTER
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30340-2761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-496-3870
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2008