Provider First Line Business Practice Location Address:
7700 HIGHWAY 69 S
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
TUSCALOOSA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35405-8783
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-349-1040
Provider Business Practice Location Address Fax Number:
205-349-4010
Provider Enumeration Date:
12/04/2006