Provider First Line Business Practice Location Address:
20 GLENLAKE PKWY
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:
30328-3473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-349-2266
Provider Business Practice Location Address Fax Number:
269-349-0792
Provider Enumeration Date:
08/17/2007