Provider First Line Business Practice Location Address:
75 HIGHWAY 136 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROEVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-575-4825
Provider Business Practice Location Address Fax Number:
251-575-7730
Provider Enumeration Date:
05/24/2005