Provider First Line Business Practice Location Address:
88960 HWY 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINEVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-396-5632
Provider Business Practice Location Address Fax Number:
256-396-5142
Provider Enumeration Date:
08/18/2006