Provider First Line Business Practice Location Address:
300 MEDICAL AVENUE
Provider Second Line Business Practice Location Address:
2
Provider Business Practice Location Address City Name:
ANDALUSIA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36420-1201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-427-2476
Provider Business Practice Location Address Fax Number:
334-427-2477
Provider Enumeration Date:
02/20/2008