Provider First Line Business Practice Location Address:
415 MEDICAL CENTER DR SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT PAYNE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35968-3421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-997-2820
Provider Business Practice Location Address Fax Number:
256-997-2890
Provider Enumeration Date:
05/23/2006