Provider First Line Business Practice Location Address:
400 COUNTRY CLUB RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36925-2027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-392-5201
Provider Business Practice Location Address Fax Number:
205-392-5636
Provider Enumeration Date:
06/22/2006