Provider First Line Business Practice Location Address:
400 MEDICAL PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATMORE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36502-3004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-368-7378
Provider Business Practice Location Address Fax Number:
251-368-3868
Provider Enumeration Date:
07/22/2005