Provider First Line Business Practice Location Address:
42ND MEDICAL GROUP
Provider Second Line Business Practice Location Address:
300 S. TWINING STREET
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-953-4415
Provider Business Practice Location Address Fax Number:
334-953-6646
Provider Enumeration Date:
07/12/2006