Provider First Line Business Practice Location Address:
455 PHILIP BLVD, SUITE 130
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE LAWRENCEVILLE MEDICAL CENTER
Provider Business Practice Location Address City Name:
LAWRENCEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-985-5006
Provider Business Practice Location Address Fax Number:
770-449-9319
Provider Enumeration Date:
04/11/2006