Provider First Line Business Practice Location Address:
4218 US HIGHWAY 31 S
Provider Second Line Business Practice Location Address:
REGION I
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35603-5039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-560-2230
Provider Business Practice Location Address Fax Number:
256-560-2249
Provider Enumeration Date:
11/09/2005