Provider First Line Business Practice Location Address:
1602 CHURCH ST SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35601-3402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-350-1458
Provider Business Practice Location Address Fax Number:
256-350-1485
Provider Enumeration Date:
10/03/2005