Provider First Line Business Practice Location Address:
45 MEDICAL ARTS CT
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36037-3871
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-382-5564
Provider Business Practice Location Address Fax Number:
334-382-9289
Provider Enumeration Date:
12/20/2005