Provider First Line Business Practice Location Address:
1414 7TH AVE SE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35601-4256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-340-0555
Provider Business Practice Location Address Fax Number:
256-340-0501
Provider Enumeration Date:
11/29/2006