Provider First Line Business Practice Location Address:
42445 HIGHWAY 195 EAST
Provider Second Line Business Practice Location Address:
VILLAGE EAST SHOPPING CENTER
Provider Business Practice Location Address City Name:
HALEYVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35565-7052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-486-8811
Provider Business Practice Location Address Fax Number:
205-486-8812
Provider Enumeration Date:
01/31/2013