Provider First Line Business Practice Location Address:
2280 HIGHWAY 35
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PELHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35124-2189
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-664-3480
Provider Business Practice Location Address Fax Number:
205-685-1477
Provider Enumeration Date:
09/22/2005