Provider First Line Business Practice Location Address:
3400 HIGHWAY 78 E
Provider Second Line Business Practice Location Address:
SUITE 316 MEDICAL ARTS TOWER
Provider Business Practice Location Address City Name:
JASPER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35501-8956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-221-7301
Provider Business Practice Location Address Fax Number:
205-221-7394
Provider Enumeration Date:
11/17/2005