Provider First Line Business Practice Location Address:
3495 PIEDMONT ROAD, NE, BLDG. 9
Provider Second Line Business Practice Location Address:
THE SOUTHEAST PERMANENTE MEDICAL GROUP, INC.
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-364-4272
Provider Business Practice Location Address Fax Number:
318-448-4903
Provider Enumeration Date:
11/02/2007