Provider First Line Business Practice Location Address:
200 MEDICAL CENTER DR SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT PAYNE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35968-3458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-997-6420
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/05/2009