Provider First Line Business Practice Location Address:
9461 AL HIGHWAY 75 STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HORTON
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35980-8399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-593-1750
Provider Business Practice Location Address Fax Number:
256-593-1711
Provider Enumeration Date:
11/08/2006