Provider First Line Business Practice Location Address:
1370 S HIGHWAY 21 BYP
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MONROEVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36460-1924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-575-7772
Provider Business Practice Location Address Fax Number:
251-575-7773
Provider Enumeration Date:
09/17/2007