Provider First Line Business Practice Location Address:
6875 DOUGLAS BLVD, SUITE
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE DOUGLASVILLE MEDICAL OFFICE
Provider Business Practice Location Address City Name:
DOUGLASVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-382-0029
Provider Business Practice Location Address Fax Number:
770-387-0306
Provider Enumeration Date:
07/20/2006