Provider First Line Business Practice Location Address:
2112 6TH AVENUE 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:
35601-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-340-1251
Provider Business Practice Location Address Fax Number:
256-353-0179
Provider Enumeration Date:
10/02/2007