Provider First Line Business Practice Location Address:
402 JOHNSTON ST SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35601-3008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-274-4196
Provider Business Practice Location Address Fax Number:
866-546-5285
Provider Enumeration Date:
02/16/2007