Provider First Line Business Practice Location Address:
20 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 20
Provider Business Practice Location Address City Name:
JASPER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35501-3464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-221-4705
Provider Business Practice Location Address Fax Number:
205-221-0489
Provider Enumeration Date:
08/30/2006