Provider First Line Business Practice Location Address:
201 POWELL ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION SPRINGS
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36089-1646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-738-2740
Provider Business Practice Location Address Fax Number:
334-738-4736
Provider Enumeration Date:
02/28/2008