Provider First Line Business Practice Location Address:
42030 HIGHWAY 195 STE B
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:
35565-7054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-485-7284
Provider Business Practice Location Address Fax Number:
205-485-7392
Provider Enumeration Date:
06/01/2005