Provider First Line Business Practice Location Address:
41254 HIGHWAY 195 STE G
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HALEYVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35565-8115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-494-7150
Provider Business Practice Location Address Fax Number:
205-485-1130
Provider Enumeration Date:
07/30/2006