Provider First Line Business Practice Location Address:
2221 HWY 78 MIDWAY PLAZA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DORA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-648-0955
Provider Business Practice Location Address Fax Number:
205-648-2162
Provider Enumeration Date:
08/20/2006