Provider First Line Business Practice Location Address:
2470 MT. ZION PARKWAY
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE SOUTHWOOD SPECIALTY CENTER
Provider Business Practice Location Address City Name:
JONESBORO
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-868-9641
Provider Business Practice Location Address Fax Number:
228-867-4855
Provider Enumeration Date:
09/11/2006