Provider First Line Business Practice Location Address:
117 WATER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNIONTOWN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36786
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-628-2241
Provider Business Practice Location Address Fax Number:
334-628-5026
Provider Enumeration Date:
08/08/2012