Provider First Line Business Practice Location Address:
5440 HILLANDALE DRIVE
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE PANOLLA MEDICINE CENTER
Provider Business Practice Location Address City Name:
LITHONIA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-322-3216
Provider Business Practice Location Address Fax Number:
770-322-3290
Provider Enumeration Date:
12/04/2006