Provider First Line Business Practice Location Address:
19330 HIGHWAY 139
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIERFIELD
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35035-3658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-665-2723
Provider Business Practice Location Address Fax Number:
205-665-1037
Provider Enumeration Date:
04/23/2008