Provider First Line Business Practice Location Address:
6541 HIGHWAY 69 S STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUSCALOOSA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35405-3965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-759-2811
Provider Business Practice Location Address Fax Number:
205-759-2979
Provider Enumeration Date:
10/06/2006